THE LIBRARY

OF

THE UNIVERSITY

OF CALIFORNIA

PRESENTED BY

PROF. CHARLES A. KOFOID AND

MRS. PRUDENCE W. KOFOID

\,

SCIENCE AND THE HEALING ART,

OB

A NEW BOOK ON OLD FACTS.

By JOHN CUSTIS DARBY, M. D.

MT. STERLING, KY.

LOUISVILLE, KY:

JOHN P. MORTON AND COMPANY.

1880

Copyright, 1880,
By JOHN CUSTIS DARBY.

L

/

PREFACE.

/

EREATA.

Page 37, third line, read chylous instead of "chylores."
*' 135, twenty -leighth line, read into instead of ''in."
" 162, thirteenth line, read nervous instead of "venous."
" 273, ninth line, read concentrated instead of "concentracted."
" 285, fourth line, YQ2i6. proscribe instead of "prescribe."
" 352, eighteenth line, read hyperdermic instead of "hypodermic."

The Author.

Mt. Sterling, Ky., April 6, 1880.

ivi3479S0

BtoloQy
L I brclvy

PREFACE.

The larger part of this book was written over six

years ago, at Lexington, Kentucky, where I practiced

medicine for thirty years. Circumstances prevented its

publication. I have not been able to see to read or

write for over eighteen years; nor was I to command

the services of an amanuensis when I wanted one.

This will explain why there is some confusion in the

arrangement of the chapters. Such as it is, I present

it to the public.

The Author.

Mt. Sterliitq, Ky., April 6, 1880.

ivi34:79S0

CONTENTS.

CHAPTER I.
Physical Laws — Dynamic Forces — Animal Life ,.,,^ 7

CHAPTER n.
A New View of Physiology 14

CHAPTER in.
Writers on Physiology 25

CHAPTER IV.
The Lymphatic System 38

CHAPTER V.
The Excretions 52

CHAPTER VI.
Animal Heat 73

CHAPTER VII.
The Liver 94

CHAPTER VIII.
The Blood 138

CHAPTER IX.
Hyperemia and Congestion 144

CHAPTER X.
The Renewal of Life 182

CHAPTER XL
Emetics and Cathartics 188

(5)

6 Contents. •

CHAPTER XII.
Cathartics 218

CHAPTER XIII.
Calomel 253

CHAPTER XIV.
Chronic Diseases 292

CHAPTER XV.
Cholera 304

CHAPTER XVI.
Treatment of Cholera 348

Appendix • 383

CHAPTEE I.

Physical Laws — Dynamic Forces — Animal Life.

The attraction of gravitation is supposed to be the expression
of the law by which the heavenly bodies revolve in their orbits.
It is, perhaps, the largest generalization of which the human
mind can conceive, for it intrudes the universe. But the attrac-
tion of gravitation is inseparable from our conception of matter.
Dynamic forces include in their definition the imponderables.
Electricity, magnetism, heat, light, and cold belong to the impon-
derables ; and it may be that dynamic forces have more to do
with the revolutions of the heavenly bodies than the attraction
of gravitation.

If light passes at the rate of one hundred and eighty-five
thousand three hundred and fifty-eight miles in a second of time ;
and if it takes one hundred and twenty years for a ray of light
to come from the nearest fixed star to our solar system ; and if
no one of the heavenly bodies ever revplves twice in the same
orbit or path, it is impossible for the human mind to conceive
how the attraction of gravitation, or a force depending upon or
originating in ponderable bodies, is exerted at distances so in-
calculable.

Astronomy is the grandest, the most wonderful, and the most
exact of all the sciences. Copernicus, Galileo, Kepler, Laplace,
and Newton apprehended the general laws by which the celestial
bodies floating in space are governed. They demonstrated those
laws by proofs which are positive. Had they waited until Kir-
ohoff discovered the composition of the surface of the sun by

(7)

8 Physical Laws — Dynamic Forces — Animal Life.

means of the spectroscope, Kepler's Laws, the Principia of
Newton, and the Mechanique Celeste would never have been
heard of.

The general laws controlling the formation of the strata of
the earth's crust; the formation of continents, with their up-
heavals and depressions; the causes determining ocean tidal
waves and atmospheric currents were apprehended by a Lyell
and a Maury, as were the laws of astronomy by the men referred
to" above. Had the study of geology commenced in the chemical
analysis of primary, secondary, and tertiary rocks; in the chem-
ical analysis of drops of ocean-water and of grains of atmos-
pheric air we should have no Lyell, no Maury. Astronomers
and geologists studied matter as controlled by physical and dy-
namic laws. The existence of fossil remains, whether vegetable
or animal, in coal-fields and limestone strata, isj in this consider-
ation, but an accident. Men have disputed, as they will continue
to dispute, whether matter had or had not an eternal existence,
but there can be no dispute that there was a time when no living
thing did exist or could exist on this planet. Life, then, had a
beginning. The theory of Mr. Darwin is an hypothesis based
upon hypotheses involving a postulate — Give us life to begin with.

We come now to consider the kingdom of living existences.
Life and death are constant laws in this kingdom. Growth, the
development of organs, and a limited period of longevity assigned
to each family, whether vegetable or animal, are also constant
laws. When either the flora or fauna die they return again to
the kingdom which antedated vitality. As the astronomer oc-
cupies his mind with suns, stars, and planets; as the physical
geographer occupies his mind with continents and oceans, with
the zones, with solar heat, with terrestrial magnetism, with aerial
and ocean currents, so should the physiologist occupy his mind
in the study of life. He should begin with its appearance as
most fully and most completely developed in either the vegetable
or animal kingdom. In the one, they should consider life in the
majestic oak ; in the other, life in man as an Apollo Belvidere in
form, with a large brain and large chest, a Napoleon in intellect.

Physical Laws — Dynamic Forces — Animal lAJe, 9

They should consider life in woman as a Venus in beauty, a
Minerva in intellect, and all that constitutes the wife and mother
in purity, love, and affection. Can they discover the source of
this intellect or the fountain of this love one whit more than the
physical scientists can unravel the mysteries of the solar and
stellar universe? The solar and stellar systems have ever been
and will ever be governed by the same physical laws and dy-
namic forces. So has it been and so will it be on the planet
which we inhabit.

The dual origin of life, the descent from parents, and the
inheritance of physical, intellectual, and moral attributes and
characteristics are as certaihly fixed laws in the kingdom of
vitality as are the attraction of gravitation, and the revolutions
of planets, suns, and stars within their orbits the laws of as-
tronomy. Agassiz divides the animal kingdom into four sub-
kingdoms : radiates, mollusks, articulates, and vertebrates. If I
understand his propositions, he teaches that if the development
theory of Mr. Darwin was the true theory of animal life the
most perfect development of a radiate should be just below a
mollusk, that the most perfect mollusk should be just below an
articulate, that the most perfect articulate should be just below
a vertebrate ; but according to him such is not the fact. The
cuttle-fish belongs to the class or family of radiates. It is one
of the largest and most powerful of animals which swim in the
seas. See Victor Hugo's Toilers of the Sea, and also a picture
in one of the cathedrals in Spain where the cuttle-fish are upset-
ting a ship, when a saint rescues them. According to Agassiz, a
humming-bird is not more like a lion or a shad-fish more like
an elephant (all belonging to the class of vertebrates) than is a
radiate like an articulate or a mollusk like a vertebrate; that
they are different original existences; that they were created as
they appear on this planet. The theory of Agassiz is that the
flora and fauna, now appearing upon the earth, were created as
we now see them. According to him men and all other animals
were created as such. Cuvier, in his Animal Kingdom, con-
siders the various forms of animal Hfe, according to their sizes

10 Physical Laws — Dynamic Forces — Animal Life.

and forms ; according to the development of the organs within
the cranium, the chest, and the abdomen, with their appurtenances
of the brain and nerves; of the chest, with the lungs, heart,
arteries, and veins, and with the abdomen, including the bowels
with their vessels, venous and arterial, and with the limbs, arms,
legs, etc. Cuvier described animals according to their outward
and general forms — skeletons and organs of the animal body.
Buckle, in his History of Civilization, says that Bichat stood
next to Aristotle among great physiological thinkers. Bichat
undertook to examine and to describe the tissues (he called them
membranes) of the organs composing an animal body, about
which Cuvier had written. Bichat taught that there were twenty-
one tissues in the human organism, and he discovered the laws
which govern many of these tissues. Since his day science has
advanced. Virchow, the world^s authority, according to scientists,
has reduced the twenty-one tissues or membranes of Bichat to
two — cells and intercellular substance; and when you come to
examine Yirchow's theory you find that the intercellular sub-
stance is itself composed of cells. The latest phase of this
microscopical theory and demonstration is, according to Heitz-
mann, of New York, as published in the February number,
1879, of the Louisville and Eichmond Medical Journal, as fol-
lows, viz: "In 1873 I published the results of my researches
on protoplasm in the Transactions of the Imperial Academy of
Science of Vienna, announcing that the protoplasm has a retic-
ular structure. Each protoplasmic lump, in a certain stage of
development, exhibits numerous conical threads, emanating from
the nucleus and inosculating with the neighboring granules of
the protoplasm. All granules are connected with each other by
extremely delicate threads, so much so that the granules must be
considered as the thickened points of intersection of a network
which traverses the map of the protoplasm, and is in connection
with a thin, uniform layer bounding the whole lump. I declared
that the nucleus, the granules, the uniting threads, and the in-
closing shell are formations of living matter, while the substance
filling the meshes and vacuoles is a fluid, and as such devoid of

Physical Laws — Dynamic Forces — AnimaJ, Life. 11

life." He objects to the cell theory of Virchow as incomplete
and indefinite. I do not know what may hereafter be discovered.
In the examination of animal life I start from his standpoint.
Beginning as I do with the higher order of animals in the study
of life, I affirm it to be an undeniable and incontrovertible fact
that all life is of dual origin. No scientist disputes this fact till
he gets so low down in the development of either vegetable or
animal life as to be unable to tell, even with the aid of the most
powerful microscope, by what laws their organization is gov-
erned. It might be said (and who could dispute the truth of the
assertion ?) that life begins in all the higher order of animals in
the spermatozoon of the male and the egg of the female. They
are living existences, but not capable of continued existence un-
less they come in contact and find a nidus. This is the birth of
the fetus in utero. All else is growth. The spermatozoon and
the egg referred to are made up of protoplasm or bioplasm, call
it which you please. The physical, intellectual, and moral traits
which distinguish the future man or woman were transmitted
from their parents to this fetus in utero. After the birth of the
fetus in utero all else is growth and development. A living
healthful boy or girl is born, and grows to be a man or a
woman. The dual origin of life involves and necessitates an-
other physiological fact which is equally incontrovertible. It is
that all life descends from parents, from parents who are fully
developed and who have the capacity of propagating their kind.
I have said that no one disputes the dual origin of life until he
gets so low down in the scale that he can tell nothing about it.
Were this not the law of animal life there would be no inherit-
ance of either good or bad qualities, nothing could be gained
from the pedigrees and the training of race-horses, and in a higher
sense we could not account for moral and intellectual character-
istics which sometimes pass through generations of men and
women. Sometimes they skip from parents to grandchildren.
Mr. Darwin and his disciples claim that the survival of the fittest
is a law of animal life. If we suppose with him and his disciples
that when life appeared on this planet it began in microscopic

12 Physical Laws — Dynamic Forces — Animal Life,

germs or spores, and was afterward developed into the four sub-
kingdoms of Agassiz, it is impossible for them to explain why-
myriads of living microscopic beings, with many that are visible
to our eyes, have not ceased to exist hundreds of years ago. Mr,
Darwin has laid great stress upon natural and sexual selection.
His whole theory of evolution and development depends upon
this law. It is a law of animal life, but we can not trace it so
far back as we can the dual origin of life, or the descent of life
from parent to child. Now these three laws, the dual origin, the
descent from parents of certain characteristic traits of form and
intellectual development, and the third law of natural and sexual
selection, all show beyond a question of doubt that life does not
begin even in bioplasm or in a cell; that it does not begin in the
spermatozoon of the male or the egg of the female, but that
it does and must begin in the life of the parents, and that the
spermatozoon and Qgg are only material forms of its transmis-
sion. Were life developed from a microscopical living entity
we could inherit nothing from our progenitors. If, according to
them, there is only a missing link between men and monkeys, I
would ask what did we inherit from them ? As time with them
is every thing, they must allow that several thousand years
should make some little change. The architects of the pyramids
of Egypt, the founders of the Brahmin and Buddhist religions,
the author of the Pentateuch, the Homers, the Platos, the Aris-
totles, the Hippocrates, and Galens, of Greece, were a little nearer
to the monkeys than we are.

Auguste Comte and John Stuart Mill, being judges of intel-
lectual capacity, I ask, are there any men to-day who excel those
worthies in mental power and moral grandeur? Life in us was
life in them. When we consider life we must consider its highest
capacities and its highest capabilities. Try as we may, we can
not avoid or get around the necessity for a creator. I have said
that there was a time when the kingdom of vitality was estab-
lished on this planet ; that prior to that time matter was gov-
erned by physical laws and dynamic forces; but these laws and
forces continued, and though they were under the dominion of

Physical Laws — Dynamic Forces — Animal Life. 13

the law of vitality, yet they influenced vital organisms; for
instance, the temperature of vitality in man is about 98° F. ; in
a tree it is less. And again, all living beings, whether animal
or vegetable, are influenced by atmospheric pressure. The zones
in which either animals or vegetables exist, the altitude of moun-
tains, the extent of plains, the ocean surroundings, atmospheric
and ocean currents altogether influence human beings. They
determine, to some extent, their forms and characteristics. And
when we examine animal bodies we find that the laws of hy-
draulics have much to do with the circulation of the blood and
other fluids within the body ; that electrical and magnetic laws
exert no less an influence and have a material system — the nerv-
ous system — for their manifestation. Sunt multi homines sed
pauci viri.

In considering vitality I write of virum — the Moses of Africa,
the Confucius of Asia, the Shakespeare of Europe, and the Wash-
ington of America, and not of the monkey-men of the Darwin-
ians. The mind of an Aristotle, of an Archimedes, of a Galli-
leo, of a Bacon, a Kepler, a Newton, a Laplace, a Morse, or a
Barlow is not a correlation of forces nor the evolution of mon-
ads. Had Captain Eads gone to the headwaters of the Missouri
and collected the little drops of water as they trickled from the
rocks of the Sierra Nevada, or gathered from the bottom of the
Mississippi the little grains of sand and analyzed them, he would
have been as well prepared to know and to understand the hy-
draulic and atmospheric forces with which he would have to
contend in building his bridge at St. Louis, or in constructing
the jetties by which to deepen the channel of the great Father
of Waters, as is the physiologist prepared to know or to discover
the laws of the life of man by vivisection, by microscopical
anatomy, or the study of the correlation of forces, or the evolu-
tion of monads. "The fool hath said in his heart there is no
God'' will be believed by mankind to be a truth when Mr.
Darwin and every one of his disciples shall have been utterly
forgotten.

14 A New View of Physiology.

CHAPTER 11.

A New View of Physiology.

Dr. Elisha Bartlett, in his work on The Philosophy of Med-
ical Science, says, " Our knowledge of physiology is not deduci-
ble from our knowledge of anatomy ; our knowledge of pathology
is not deducible from our knowledge of physiology." In the
chapter on pathology he says, " In the preceding chapter I have
endeavored to exhibit the independent nature of our knowledge
of physiology. I propose in the present to treat in the same
manner of pathology. I wish to show in the first place that our
knowledge of the morbid processes and susceptibilities of the
several organs and tissues of the body can not be inferred from
our knowledge of their healthy processes. Pathology is not
founded upon physiology. The latter is not the basis of the
former; the one does not flow from the other; our "knowledge of
the one does not presuppose our knowledge of the other.'' Dr.
Bartlett applies the same principles to therapeutics and the prac-
tice of medicine. In a review of this work published a short
time after its appearance, in 1844, in the Louisville Medical and
Surgical Journal, I said, " Dr. Bartlett reminds me of a boy lost
in his father's forest. He knows every tree by name, an oak, an
elm, a maple, a poplar, etc., but does not know how to find his
way out of the forest."

It is to show the connections and relationships between
some of the departments of medical science that the pres-
ent volume is undertaken. When a child is born in perfect
health, whose father and mother had been sound in mind and

A New View of Physiology, 15

body during their entire life, and grows to maturity having
enjoyed perfect health, the law of constructive assimilation has
alone been active. The living part of the bioplasm found in the
embryo or fetus in utero continues to be developed into organs
and to increase in size until we have a perfectly formed man or
woman. The tissues composing the body of this man or woman
continue to exist until death. The non-living parts of the several
organs, like the non-living fluid which surrounds the threads in
the bioplasm, are continually changing, but the original structure
remains unchanged. It may be distorted by disease or accident,
but that does not alter its identity. The laws of constructive as«
similation and of destructive metamorphosis are like the tides —
the ebbtide never begins to flow until th§ floodtide ceases, and
so the floodtide until the ebbtide ceases.

Physiologists, I believe, all agree that effete matter was once
a part of the living organism, and that it is separated from the
tissues or organs by or through the laws of destructive meta-
morphosis. All effete matter is excrementitious, but all excre-
mentitious matter is not, or was not, effete matter. Time was
when it was said that an animal body was changed in seven
years. Now science, so-called, declares that animal bodies are
changed in twenty-one days. Dr. Draper, in his Intellectual
Development of Europe, makes a digression to say that a ton
and a half of food and drinks pass through the body of a man
weighing one hundred and fifty or sixty pounds in one year, all
having been a part of his living organized tissues. Dr. Thomas
King Chambers, in his work called the Kenewal of Life, refers
to the Morgue in Paris, and says that a dead body there exposed
does not undergo decomposition in so short a time as the body
of a living person. As an illustration he presents a brick wall
and says that we continually take out an old brick and put in a
new one. The illustration is, I think, an unfortunate one, as
this earth is not yet old enough to tell how long a brick will
last. Dr. Dalton, in his learned work on Physiology, makes
a more accurate calculation than Dr. Draper. He weighed
the amount of food and drinks a man weighing say one

16 A New View of Physiology.

hundred and fifty pounds consumes in twenty-four hours, and
then gives with equal accuracy the amount of excrementitious
matter thrown from the body in twenty- four hours; all of
which is, according to him, effete matter. A man weighing
from one hundred and forty to one hundred and fifty pounds,
who swallows seven pounds and a half of food and drink
in twenty -four hours, will thus be entirely changed in from
twenty-one to twenty-two days. The entire system of modern
physiology is founded upon this doctrine. According to it,
there is not an atom of matter in the body of a living man
to-day which was in it one month ago. The food and drinks
that we swallow are first mixed with the saliva, then with
the gastric juice, and next with the pancreatic and intestinal
juices and with the bile, if you please. By these intermixtures
the food and drinks are changed into three forms. The oily
portions of the food are changed into what is called fatty emulr
sion. The amylaceous forms of food are changed into glucose,
and the nitrogenous forms of food are changed into albuminose.
Ordinarily the fatty emulsion is all, or nearly all, taken up by the
lacteals and conveyed to the mesenteric glands, and thence to
the receptaculum chyli. There it is mixed with the lymph and
passes through the thoracic duct to the vena cava descendens,
and thence into the right side of the heart. The glucose and
albuminose forms of food are taken up by the veins of the
stomach and intestines and thence carried through the portal
vein to the liver. From the liver they are carried through the
hepatic veins to the vena cava ascendens, and through it to the
right side of the heart. There meeting with the fatty emulsion
they are mixed together and pass thence into the lungs. Pass-
ing through the lungs, they enter the left side of the heart
through the pulmonary veins. When these three forms reach
the left side of the heart they are called blood ; indeed I do not
know that I should follow these three forms of food as far as the
left side of the heart. If they are not called blood as soon as
they are absorbed from the stomach and intestines, physiological
writers have taken no pains to say so. According to them the

A New View of Physiology. 17

three forms of food are like so many race-horses. They each and
all rush to some particular part of the animal organism, there to
become a part of the living tissues; or, if you please, to lay
down a new brick in the place of an old one which has been
removed. It will thus be seen that the roast beef and vege-
tables which we ate for dinner on Saturday are to-day (Monday)
a part of our bodies. The practice of medicine, which the most
distinguished writers profess to call scientific, is based upon this
physiological doctrine.

According to Dr. Thomas King Chambers they have in the
London hospitals night- as well as day-nurses, whose business it
is to see that every patient drinks a certain quantity of milk or
beef tea every three hours, and if the patient is asleep he has to
be wakened. Science has forgotten Sancho Panza, who said,
^' Blessed is the man who invented sleep." Milk and beef tea
are the mildest forms of diet, and this stuffing is to put a new
brick into the place of an old one, which, according to science,
is continually passing out of the wall. This practice is not con-
fined to London hospitals. It may be modified, but it is pur-
sued by the scientific physicians of both Europe and the United
States.

I teach that when a man is subjected to starvation or is sick,
then the law of destructive metamorphosis begins in his body,
and that while this law continues to operate the law of construct-
ive assimilation is suspended ; that so long as the starvation or
sickness continues no part of any of the three forms of food
absorbed from the stomach or intestines becomes a- part of the
living organism; that when the starvation or sickness ceases
and the individual obtains food, or begins to get well, then the
law of constructive assimilation begins to operate, and that then
the three forms of food are ultimately changed into living organ-
ized forms. When the three forms of food spoken of are ab-
sorbed, I say that the conversion of the food into blood has then
hardly begun. I do not say that patients require no food during
fevers; but* this is not the place for the consideration of that
question. I teach that every gland in the body, except the

2

18 A New Vieiv of Physiology,

reproductive glands, is exclusively and entirely engaged in the
conversion of the food into blood preparatory to the formation
of tissues from the blood. I here speak of tissues in the sense
of Bichat.

I will now endeavor to show how the food is converted into
blood. I have said that the oily portion of the food, or fatty
emulsion, is conveyed by the lacteals to the thoracic duct, and
thence to the right side of the heart. In its passage through
the mesenteric glands it is subjected to certain vital changes.
Virchow says he saw white corpuscles as they came out from
those glands. They are formed or generated by other lymphatic
glands. The two forms of food which pass to the liver through
the portal vein are there subjected to certain vital changes neces-
sary to their becoming constituent parts of the blood. Bichat
observed, in the early part of this century, that the bile begins
to be poured into the duodenum almost immediately after diges-
tion commences. I teach that this bile, the clear and compara-
tively sweet bile, is an excrementitious substance formed from
glucose and albuminose forms of food as they pass through the
liver; that this bile is a substance necessarily separated from
these forms of food in their metamorphosis into the constituent
parts of the blood. Physiologists teach that two pounds and a
half of bile are ordinarily secreted by the liver of a healthy man
during every twenty-four hours. I say that the greater part of
this bile is formed from the food as it passes through the liver.
There is another form of bile — the dark, viscid, bitter bile. I
hold that this form of bile is formed from effete matter brought
from the abdominal organs in its return to the right side of the
heart. It is not denied that all of this blood has to pass through
the liver before it reaches the vena cava ascendens. The conver-
sion of effete matter into bile is effected by the liver for the most
part after the forms of food referred to have passed through the
liver. The formation of bile from effete matter will be consid-
ered in another place. I teach that the larger part of the bile
in health is formed from the food as it passes through the liver,
and that a lesser part is formed from effete blood as it passes

A New View of Physiology, 19

through the liver. No physiologist teaches that bile is thus
formed or that it is formed from the elements and substances out
of which I say it is made. Dr. Murchison, in his valuable little
work on Functional Derangements of the Liver, says that the
bile is formed from the albumen in the blood. I believe that
physiologists generally agree with him. Not one of them, so far
as I know, has ever taught that a portion of the bile, and, as I
believe, a large portion, is formed from the food as it passes
through the liver, and they all deny that any part of the bile is
formed from effete matter. Effete matter is, according to them,
separated from the blood and thrown off from the body by two
organs — the lungs and the kidneys, but particularly by the latter.
I believe they also teach that effete matter is to some extent
thrown off by the skin. Were they to allow that the bile is
formed from effete matter they would be compelled to admit that
the bile is an excrementitious substance, because they all teach,
and they are compelled to teach, that effete matter is a substance
which has to pass out of the body. This denial that the bile is
formed from effete matter involves them in the assumption that
the bile is an incrementitious and not an excrementitious sub-
stance, and also involves them in the other assumption that the
bile is continually reabsorbed. There is some little qualification
as to the reabsorption of the bile. Cholesterin, one of the frac-
tional parts of bile, is, they say, converted into stercorin, and
thus passes out of the body. The general assumption that the
bile is for the most part reabsorbed, and that it is not entirely
and altogether an excrementitious substance, involves them in
a dilemma. To answer this difficulty, Claude Bernard had dis-
covered, and the so-called scientific medical world is in acclama-
tion at his discovery, that the liver possesses glycogenic func-
tions, and that it is the special function of the liver. Sugar,
under some of its forms, is said to be sometimes found in the
blood of the hepatic veins. I think it is more than doubtful that
it ever was there found when the animal, the blood of which was
examined, was in perfect health. Bichat said that physiological
laws could not be discovered when the body of the animal ex-

20 A New View of Physiology.

perimented on was in torture. I agree with him. It is the
function of the liver to change the two forms of food, glucose
and albuminose, coming to it from the stomach and intestines
into something nearer akin to blood. When we consider how
large a portion of our food is of a saccharine composition, is it
strange that the liver is sometimes unable to change it, and that
it passes into the hepatic^ veins as sugar? Ordinarily the fatty
emulsion coming up through the thoracic duct to the right side
of the heart is so changed in its passage through the lungs that
it does not appear as fatty emulsion in the blood of the carotid
artery, but sometimes it does there so appear. In the same man-
ner sugar sometimes passes through the liver and is found in the
blood of the hepatic veins. But it is said that sugar is found in
the hepatic veins of animals which feed entirely on flesh. This
may be a fact. I doubt it. To make the most of Claude Ber-
nard's discovery, all that can be said of it is that when the liver
acts upon the glucose and albuminose which come to it inti-
mately mixed together, it separates from them substances out
of which it makes the sweet bile, and that, in that separation
and vital action upon these forms of food, one of them, the glu-
cose, may be changed into glycogen.

I hold that one of the functions of the liver is to change the
food into something nearer akin to the constituent parts of the
blood. These two forms of food, having thus been acted upon
by the liver, pass on to the right side of the heart. They there
meet with the fatty emulsion which had already been subjected
to the action of the mesenteric glands. These all mixed together
with a great quantity of lymph pass directly to the lungs, where
they are acted upon by the inspired air. It is supposed by phys-
iologists generally, I believe, that some portion of the food is
consumed as it passes through the lungs, in the production or
generation of animal heat. When these three forms of food
reach the left side of the heart, having already been subjected
to the vitalizing action of the liver, of the mesenteric glands,
and of the lungs (for in this sense I consider the lungs to be
glands), they are distributed to all parts of the body. They

A New View of Physiology » 21

have yet, however, to be subjected to the action of the other
glands before they can be called blood. The lymphatics, like
the veins, originate in all parts of the body. In a physiological
sense the lymphatics separate from the blood in the arterioles
certain parts of the food which they carry to the lymphatic
glands, where it undergoes another vital action. From these
glands it passes on to the thoracic duct. Lymph corpuscles are
found in large numbers in the lymph as it is about to pass into
the right side of the heart. When these corpuscles have passed
through the lungs and on to the left side of the heart, they no
longer appear in the blood of the carotid artery, for instance,
except in the proportion of one white corpuscle to three hun-
dred red ones, which, accorjjing to Virchow, is their normal
proportion in the arterial blood of a man in perfect health.
They become red blood corpuscles in their passage through the
lungs.

Considering the size of the kidneys a very large quantity of
arterial blood is sent to them. For what purpose is it sent?
This arterial blood, sent to those organs, contains three forms
of food which is to be subjected to another elimination in the
kidneys. They have to separate a large portion of the liquids
with which the food had been mixed up. I refer to the saliva,
the gastric juice, the pancreatic, and intestinal juices. They also
separate certain solid constituents, all of which are poured into
the bladder. Recent physiological facts have shown that the
purest blood found in the body is that coming immediately from
the kidneys. It is because the food, under its three forms, had
been subjected to one of its last eliminations in its passage
through those organs. The renal veins convey to the vena cava
this pure blood. The glands of the skin have also to perform
their part in the conversion of the food into blood. This they
do in the elimination of watery parts, which they throw off as
insensible perspiration.

This is the round of the changes and glandular actions to
which the food is subjected before it becomes blood, or can prop-
erly be called blood ; but it has to be subjected to another large

22 A New View of Physiology,

gland. I refer to the spleen. The blood which comes from the
spleen has a larger amount of fibrin in it than had the blood
which was conveyed to it through the splenic artery. I believe
it also contains a larger number of white blood corpuscles. The
spleen is continually pouring into the portal vein rejuvenated
blood. It is out of the blood thus prepared or made, as I have
so fully stated, that the tissues are formed. This formation, or
constructive assimilation, goes on from the beginning of life until
the man or woman has arrived at a mature growth. During all
this time the excrementitious matter thrown out from the body
was separated from the food. I affirm that no effete matter was
separated from the tissues during all this time if the individual
continued in perfect health. After the individual has arrived at
mature growth, the food which has up to this time been formed
into the living tissues, is now used in maintaining the strength,
the animal heat, and all other functions, without being metamor-
phosed into living organized tissues or parts of the body. It is
then, and then only, that the excrementitious matter corresponds
so nearly in weight with the amount of food and drinks swal-
lowed. When a growing child is gaining a pound a day in
weight, there can be no such correspondence. Indeed some
physiological writers maintain that pigs sometimes increase in
weight beyond the amount of food and drinks consumed. The
notion that destructive metamorphosis is continually going on in
healthy animals, thereby separating from the tissues eifete matter,
involves another difficulty. What becomes of this effete matter?
A large part of it, they say, is separated from the blood by the
kidneys. I teach that neither effete matter nor effete blood ever
reaches the left side of the heart. When it is separated from
the tissues and emptied into the veins it is removed from the
blood by the liver, forming out of it the viscid, dark, bitter bile.
The liver takes from the blood all effete matter brought to that
gland through the portal vein. It changes it into bile, which is
an excrementitious substance. The lungs also separate effete
matter, when there is any, from the blood, and throw it off as
carbonic acid. When there is no effete matter the lungs throw

A New Vie)/) of Physiology, 23

off effete blood as it passes through them. When the blood is
not converted into tissues it becomes itself effete, and has to be
thrown off from the body by the liver and lungs. But physiol-
ogists teach that effete matter, which is continually being sepa-
rated from the tissues, is formed into urea, cholesterin, etc.

Dr. Murchison, in the work already referred to, says that one
of the functions of the liver is the production of urea, and
that sometimes the liver generates or makes uric acid or the
urates. Where glands or organs are provided for every dis-
tinct function, as in the bodies of the more fully developed
animals, it is contrary to the uniform simplicity of nature for
any one gland to perform three or four functions entirely dif-
ferent. In pathological conditions glands may act vicariously
for each other, but it is not so in perfect health. It is the
especial function of the kidneys to separate certain parts from
the food which they form into urea, and every other thing found
in the bladder. They are as much organs engaged in sanguifi-
cation as are the salivary glands, the stomach, the liver, and
the lungs. If the liver formed urea out of any part of the
blood, that urea ought to be immediately put into a channel
which would remove it from the body. It ought to pass from
the liver along with the bile and be poured into the duodenum.
But physiologists teach that the urea formed by the liver passes
through the hepatic veins into the vena cava. A poison thus
formed is sent into the general circulation to be distributed to
all parts of the body. If it were possible to conceive that
urea is ever poured into the vena cava of the healthy man, it
ought to be separated from the blood as it passes through the
lungs, and thrown out of the body along with the expired air.
But such is not the doctrine of the schools. They teach that
urea and several other poisons enter the left side of the heart
and are distributed to every part of the body. I say they
teach this unless they suppose that urea and other poisons are
taken by some elective affinity through the renal arteries to the
kidneys, there to be separated, as they say, from the blood. The
whole thing is an absurdity.

24 A New View of Physiology,

The above outline of the doctrines which I propose to discuss
in this book is taken in part from an article I wrote for the St.
Louis Medical and Surgical Journal, of February, 1878. Let
the reader bear in mind that in this chapter I have considered
physiological and not pathological conditions. This applies par-
ticularly to what I have said as to effete matter and the offices
of the lymphatic vessels.

Writers on Physiology, 25

CHAPTER III.

Wkiters on Physiology.

As some persons may read this book who are not physicians,
we will quote occasionally from medical authorities, so that they
may know what is taught in the schools. And first we will quote
a few extracts from two of the most distinguished medical au-
thorities in the United States touching questions alluded to in
the foregoing chapter.

Dr. Dalton, in his work on Physiology, says, "We can now
estimate from the foregoing details the entire quantity of material
assimilated and decomposed by the living body. For we have
already seen how much food is taken into the alimentary canal
and absorbed by the blood after digestion, and how much oxygen
is appropriated from the atmosphere during the process of res-
piration. We have also learned the amount of carbonic acid
evolved with the breath and that of various excretory substances
discharged from the body. The following table shows the abso-
lute quantity of these diiferent ingesta and egesta, compiled from
direct experiments which have already been given in the forego-
ing pages :

"Absorbed During Twenty-four Hours.

"Oxygen, .
Water,

. 1.019 pounds.
4.735 "

Albuminous matter,
Starch,

Fat,
Salts, :

. .396 "
.660 "

. .220 "
.040 "

Total,

. 7.070 "

26 Writers on Physiology.

"Discharged During Twenty-four Hours.

Carbonic acid,

.

. 1.535 pounds

Aqueous vapor,

1.155 "

Perspiration,

.

. 1.930 "

Water of the urine, .

2.020 "

Urea and salts,

,

. .110 "

Feces,

.320 ''

Total,

,

. 7.070 "

" Rather more than seven pounds are therefore absorbed and
discharged by the healthy adult human subject; and, for a man
having the average weight of one hundred and forty pounds, a
quantity of material equal to the weight of the entire body thus
passes through the system in the course of twenty hours. It is
evident also that this is not a simple phenomenon of the passage
or filtration of foreign substances through the animal frame. The
materials which are absorbed actually combine with the tissues
and form a part of this substance, and it is only after under-
going subsequent decomposition that they finally make their
appearance in the excretions. None of the solid ingredients of
the food are discharged under their own form in the urine, viz.
as starch, fat, or albumen; but they are replaced by urea and
other crystallizable substances of a different nature. Even the
carbonic acid exhaled by the breath, experience has taught us,
is not produced by a direct oxidation of carbon, but originates
by a process of decomposition throughout the tissues of the
body somewhat similar to that by which it is generated in the
decomposition of sugar by fermentation. These phenomena,
therefore, indicate an actual change in the substance of which
the body is composed, and shows that its entire ingredients
are incessantly renewed under the influence of the vital oper-
ations.

"From experiments while living on an exclusive diet of bread,
fresh meat, and butter, with coffee and water for drinks, we have
found that the entire quantity of food required during twenty-
four hours, by a man in full health and taking free exercise in
the open air, is as follows, viz :

Writer's on Physiology, 27

**Meat, 16 ounces, or 1.00 lbs. avoirdupois.

Bread, 19 " 1.19 " *'

Butter and fat, 3J '* .22 *' "

Water, 52 fluid oz. or 3.38 *' ''

"That is to say, rather less than two and one half pounds of
solid food and rather over three pints of liquid food. Of course
the quantity varies according to circumstances, the kind and
quantity of the food, and the constitution of the individual."

After a careful examination of Flint's Physiology, 1 can not
find that he differs from Dalton as to the positions taken by the
latter in the above extract. Dr. Draper certainly agrees with
him. Now if in an animal body the ingesta and egesta, includ-
ing the oxygen inspired and the carbonic acid exhaled, exactly
balance each other, I confess that it is beyond my comprehension
to see how a child or a pig could grow or increase in weight.
I conjecture that the experiment made by Dr. Dalton was on a
fully grown individual whose weight remained stationary. I
alluded in the last chapter to a fact; given I think by a German
physiologist, that pigs sometimes increase daily more in weight
than is contained in the food and drinks swallowed by them.
The fact may be true; its explanation must be conjectural. Or-
dinarily we know that young and growing animals, including
man, gain but a small proportion in weight daily compared with
what they eat and drink. I differ totally from Dr. Dalton in
his supposition that during healthful growth any part of the
organized forms in a living body is separated from it and be-
comes effete matter. How the excreta to which he refers are
formed, and how they escape from the body, I will notice in
another connection.

Dr. Flint says, "Assuming the daily allowance of bread to
be nineteen ounces, and estimating the allowance of meat to be
sixteen ounces, and the quantity of saliva secreted during twenty-
two hours of interval, the entire quantity in twenty-four hours
would amount to twenty thousand one hundred and sixty-four
grains, or a little less than three pounds avoirdupois, of which
rather more than one half is secreted during the intervals of eat-

28 Writers on Physiology.

ing. All that portion of saliva secreted while we are masticating
our food is mixed more or less intimately with it and passes into
the stomach and intestines and is again taken up by the venous
absorbents. This saliva is secreted from arterial blood. This
first addition to the food is the beginning of the change in it
from dead matter into living blood." As to the gastric juice,
the next addition to the food, Dr. Flint says, " Estimates, there-
fore, like Bidder's and Schmidt's, who put the quantity of gastric
juice secreted in twenty-four hours by a healthy man of ordi-
nary size at six thousand four hundred grams, or about fourteen
pounds, are probably not exaggerated, though of necessity they
are merely approximative. This estimate for quantity is a very
high one, but the authorities for it stand in the first rank of
physiologists."

That part of the food which is prepared by the stomach for
absorption, by its admixture and union with the saliva and gas-
tric juice, and which is taken up by the venous absorbents of the
stomach, passes directly to the liver. The remainder of the con-
tents of the stomach passes into the duodenum. The next addi-
tion to the food is multiple. As it passes out of the stomach into
the duodenum it begins to be mixed with the pancreatic juice,
with the bile, and with the intestinal juices. The intermixture
with the latter continues throughout the small intestines. The
quantity of the intestinal juice is supposed by physiologists to
be very, large, perhaps more than the saliva and gastric juice
combined. Dr. Flint says, "There is no accurate basis for an
estimate of the quantity of pancreatic juice secreted in the
twenty-four hours in the human subject or of the quantity
necessary for the digestion of a definite amount of food."

The composition of the human bile is as follows:

Water, .... 915.00 to 819.00
Taurocholate, or choleate of soda

(NaOC52H45NOi4S2), . 56.50 to 106.00
Glycocholate, or choleate of soda

(NaOC52H42NOii), . traces

CholesterinCCasHgaO), . 1.00 to 2.66

Writers on Physiology

Biliverdin,

Lecithin, margarin, olein, and

traces of soaps,
Choline (Ci.HieNO^),
Chloride of sodium,
Phosphate of soda, .
Phosphate of potassa, .
Phosphate of lime, .
Phosphate of magnesia,
Salts of iron,
Salts of manganese,
Silicic acid,
Mucosin,
Loss, .

29

14.00 to 30.00

3.00 to 31.00

traces
2.77 to 3.50
1.60 to
0.75 to

0.50 to
0.45 to
0.15 to
traces to
0.03 to

traces
3.45 to 1.21

2.50
1.50
1.35
0.80
0.30
0.12
0.06

1000.00 1000.00

I think that some physiologists estimate the quantity to be
several pints, perhaps more. Physiologists generally estimate
the quantity of bile secreted in twenty-four hours in a man of
ordinary size to be two and a half pounds. It will be seen that
the food and drinks are intermixed with fluids, the saliva, the
gastric, intestinal, and pancreatic juices, which exceed them in
quantity three or four, perhaps six or eight, times ; for physiolo-
gists do not agree with any accuracy as to the quantity of these
juices secreted. It is a noteworthy fact that they are all secreted
from arterial blood. The bile, on the other hand, is secreted from
venous blood, or rather, I shouUl say, from a fluid brought to
the liver through the portal vein. Physiologists all agree, I
believe, that when glands are actively secreting there is a sus-
pension of the process of disassimilation in their organisms;
that is to say, no eifete matter is separated from the tissues of a
gland while it is secreting actively, or secreting at all perhaps.
The saliva, gastric and other juices named above do not con-
tain eWete matter, except a fractional part of epithelium. These
fluids are all intermixed with the food to prepare it for absorp-
tion by the veins and lacteals; to prepare it, the food, for its
transformation into blood. They are absorbed, it is true, along
with the food — that is, the greater part of them ; but as they are

30 Writers on Physiology.

each and all of them secreted at and during every meal we must
suppose that those secreted yesterday must escape from the body
within a given time.

Now I suppose (for I do not know that the question has ever
been accurately considered) that the escape of water and aque-
ous vapor from the body through the kidneys, lungs, and skin
will not correspond exactly with the quantity of water and other
fluids drunk and with the quantities of saliva, gastric, and other
juices secreted. I therefore suppose that a large proportion of
the two and a half pounds of bile secreted daily and poured out
into the duodenum is what is allotted to the liver to throw oif
from the body of these fluids. If I am correct in this opinion
then the bile is quoad hoc an excrementitious fluid. If the sep-
aration of effete matter is in abeyance while glands are secreting,
the veins going from the stomach and intestines to the liver dur-
ing digestion must be filled almost altogether by the food and
the juices with which it is intermixed. In this connection I am
only considering the functions of the liver as an organ of san-
guification.

For the benefit of the general reader I will here give an out-
line of the circulation of the blood.

The circulation of the blood in the human body is carried on
through four systems — the systemic, the pulmonary, the capil-
lary, and the portal system.

The systemic is divided into two — the arterial and the ve-
nous. By the arterial system the blood is carried from the
left ventricle of the heart through the aorta and arteries to all
parts of the body. The arteries have no valves in them. By
the venous system the blood is carried from all parts of the
body to the right auricle and ventricle of the heart. The veins
distributed through the superficial parts of the body, includ-
ing the limbs and all muscular parts, have valves in them.
By the venous system the blood is carried from all parts of the
body to the right auricle or ventricle of the heart. Dr. Austin
Flint says, "A great discovery preparatory to that of the cir-
culation was made by Fabricius ab Aquapendente, professor at

Writers on Physiology, ^ 31

Padua, who, in the words of Flourens, had a double glory : ' He
discovered the valves of the veins and was the master of Har-
vey.' This was demonstrated to Harvey at Padua, though Fabri-
cius does not appear to have had any idea of their functions. It
is possible that this anatomical fact may have directed the mind
of Harvey in his first speculations on the circulation. Harvey
observed the knots in the veins of the arm when a ligature is
applied, as for phlebotomy, and showed that the spaces between
these knots which are formed by the valves could be emptied
of blood by pressing toward the heart, and would not fill with
blood while the finger was kept at the lower extremity. It was
impossible- by pressure with the fingers to force the blood back
through one of the valves.^'

Notwithstanding the very high estimate thus expressed by
Dr. Flint of our knowledge of the existence of valves in the
veins and their offices, very little importance has been attached
by medical men to the uses of the valves in their explanations
of the phenomena of disease. We will refer more particularly
to them hereafter, and point out in what parts of the venous
system they are absent.

The capillary system lies intermediate between the extremities
of the arteries or arterioles and the microscopical rivulets which
are the beginnings of the veins. It is here that assimilation or
constructive metamorphosis is effected ; in other words, it is in
the capillary system that the materials of the blood are converted
into living tissue. It is in the capillaries also that disassimila-
tion or destructive metamorphosis is effected. Here carbonic
acid is liberated or generated and passes with other effete matter
into the venous blood, causing it to become dark in color. The
capillary system is distributed through all parts of the body.
But we must call attention to the circulation of the blood in the
capillaries of the glands. When the parotid or mammary glands
are secreting actively, the blood passing through them does not
become darker in color in the veins, as is usually the case; in
other words, the separation of effete matter seems to be sus-
pended while the secretory functions of the glands are being

32 . Writers on Physiology.

performed. This fact has been observed by all recent physiolo-
gists. Constructive and destructive metamorphosis seem to be
suspended while active secretion is going on in a gland. The
blood returning from a gland through the veins is almost as red
as that which enters it through the' arteries. I desire the reader
to pay particular attention to this fact. The whole volume of
blood from all parts of the body is returned to the right side
of the heart through the ascending and descending vena cava,
which empty into the right auricle of the heart. The capillary
system is an intermediate division which lies between the arte-
ries and veins.

Third. The pulmonary system is peculiar in this, that the
venous blood is carried from the right ventricle to the lungs
by an artery — the pulmonary artery. After throwing off car-
bonic acid and absorbing oxygen in the lungs, blood is said to
be aerated, that is, it becomes arterial, and is returned through
the veins — the four pulmonary veins — to the left auricle and ven-
tricle. It will be observed that in both heart and lungs the
whole volume of blood passes immediately through each. These
two organs never rest. The suspension of action in either causes
instant death. Such a law does not apply to the capillary sys-
tem ; that is to say, the circulation may be suspended for a time
in parts of the capillary system without causing any serious
difficulty. The lungs are supplied by an independent system
of blood-vessels for their nutrition. I refer to the bronchial
arteries and veins, which are entirely independent of the great
current of blood passing through those organs.

Fourth. The portal system. Arterial blood is conveyed, as
elsewhere, to all the abdominal organs ; but the venous blood,
returning from the stomach, the whole of the intestines and
their appendages, from the pancreas and spleen, does not go
immediately back to the heart, as it does from every other part
of the body, but is emptied into the great portal vein, which
pours its contents into the liver. The portal vein and its
branches have no valves in them. Intermediate or between the
arteries which go to supply the organs just named and the veins

Writers on Physiology, 33

returning the blood from them lies their division of the capil-
lary system. Every one at all acquainted with comparative
anatomy knows that the lungs and the liver are supplementary
organs; that in animals — moUusks, for instance — where the
livers are enormously large in comparison with the size of their
bodies, the breathing apparatus is correspondingly small, and that
in animals where the breathing apparatus is very large in com-
parison with the size of their bodies the livers ar^ in them also
correspondingly small. The portal circulation is unlike that of
any other part of the animal organism — that is, in man. Arte-
rial blood is carried to the liver through the hepatic artery,
which is very small in comparison with that gland; very much
smaller in comparison with the liver than are the renal and
splenic arteries in comparison with the kidneys and spleen.
Except in the glands which secrete, the blood, which is conveyed
to every part of the body — to the brain, to the muscles, bones,
etc. — is intended to maintain the integrity of those organs and
to enable them to perform their functions, whatever they may
be; and it also goes to repair wasted tissues, when there is any
waste, and to increase the size of organs in growing animals. I
maintain, and I do not see how any physiologist can dispute the
fact, that the blood conveyed to the liver through the hepatic
artery is for the exclusive purpose of maintaining the integrity
and vitality of that organ, and to enable it to perform its func-
tions ; that the office of the bronchial arteries and of the hepatic
artery is one and the same.

Then we must inquire why so large an amount of blood is
conveyed to the liver through the portal vein. We have seen
that part of the blood found in the portal vein comes from
organs which had been engaged in secreting certain juices, as the
gastric, pancreatic, etc. The secretion of those juices from arte-
rial blood, brought to the secreting glands or organs, left the
venous blood flowing from them in an impoverished or eifete
condition. This venous blood is conveyed to the liver, there to
be acted upon for some purpose. I maintain that that purpose
is to form bile out of it, the dark, viscid bile ; but I will not

3

34 Writers on Physiology.

consider this question at this time. The other part of the fluid
conveyed to the liver through the portal vein is the food which
has been absorbed from the stomach and intestines. The older
physiologists of modern times taught that after the food was con-
veyed to the stomach it was converted into chyme; that after it
passed out of the stomach into the duodenum it was changed
into chyle ; and that this chyle was all .absorbed by the lacteals
and conveyed through the mesenteric glands to the thoracic
duct. Magendie was, I believe, among the first of modern phys-
iologists to show that the food was not all absorbed by the lac-
teals, and that a large portion of it was absorbed by the veins in
the stomach and intestines. Dr. Murchison says, in the work to
which I have already referred, that Galen, one of the earliest
and most distinguished of the Greek physicians, entertained the
same opinion. How he arrived at that knowledge or conclu-
sion I leave for those physiologists to determine who maintain
that we can not ascertain the laws of life without the microscope
and visible experiments made on living animals. My attention
was first called to what may be called a demonstration of this
venous absorption by an article, a monograph of M. Guersant,
of Paris, on Carreau, the Cachexia Africana of the United States.
He gives the instance of a man who was executed. To every
appearance he was well and robust. He was, at any rate, corpu-
lent. The autopsy showed that the mesenteric glands were
completely degenerated; they were extraordinarily large and of
a cheesy consistence. In that man's case all the food, including
fats and oils, must have been taken up by the venous absorbents
and carried to the liver. I suppose that the fact is not now dis-
puted that that portion of the food principally which is composed
of bread, rice, fruits, and vegetables, and that composed of meats,
are absorbed by the veins and conveyed through the portal vein
to the liver. Physiologists differ, I believe, as to the amount of
fatty emulsion taken up by these venous absorbents; and also
whether the lacteals do not convey to the thoracic duct some por-
tion of one or both of the other two forms of food. The ques-
tion, it seems to me, ought to arise in the mind of every thinking

Writers on Physiology, 36

physiological investigator, why so large an amount of the food
absorbed should pass through the liver before it enters the gen-
eral circulation? I have expressed the opinion in the second
chapter that the bile, which begins to be poured out into the
duodenum almost immediately after the food reaches the stom-
ach, is formed from the food and drinks and the juices with
which they are intermixed ; and that the two pounds and a half
of bile which are poured out from the liver into the duodenum
every twenty-four hours in a man of ordinary size is thus to be
accounted for. This applies to a condition of perfect health.
The formation of bile from effete matter will not here be consid-
ered. This opinion I claim to be original with me. The older
physiologists, I believe, did not dispute the fact that bile was
foraied from effete matter. But as all physiologists who now
claim to be scientific investigators deny both of my propositions,
it remained for M. Claude Bernard, in 1848, to discover that the
liver possessed glycogenic functions, and that indeed the sugar-
making processes going on in the liver constituted its principal
function. 'This discovery was arrived at by means of the micro-
scope and vivisection. It has also been discovered, according to
the same scientific investigators, that urea is another one of the
substances generated or produced in the liver of a perfectly
healthy man. I will notice this last in another place. The bile
not being formed from the food and its intermixtures, nor from
effete "matter, according to the highest scientific authorities, we
ask, from what is it formed? They s^y that it is formed from
albumen, one of the constituent parts of healthy blood. When
we ask again, what becomes of it (the bile) and what are its uses,
we are told that it is poured into the duodenum to be mixed with
the food to prepare it for absorption, and that it is all or nearly
all reabsorbed along with the food and the juices with which it
is intermixed. Cholesterin, a fractional, crystallizable substance
found in the bile, is changed, they say, into stercorin, and passes
off with the feces. Physiologists do not deny that not a single
constituent part of the bile can be found in the blood of the
portal vein of a healthy man ; and yet the knowledge of that

36 Writers on Physiology,

fact does not prevent them from maintaining that the bile, with
the exception referred to, is all reabsorbed. No physiological
writer has ever claimed that the saliva, after it is poured out into
the mouth, ever returns to the salivary glands, nor that the
gastric juice and the pancreatic and intestinal juices are ever
returned to the glands secreting them. After they are secreted
they are permitted to pass out of the body through the kidneys,
skin, and lungs. When it is considered how large a proportion
of the food consumed by individuals living in tropical and tem-
perate climates is composed of substances convertible into glu-
cose, one of the forms of sugar, we say it is not strange that
sugar should sometimes be found in the blood of the hepatic
veins which empty it into the vena cava. We have referred to
the fact that the lungs and liver have corresponding duties to
perform.

Dr. Dalton, in his Physiology, page 157, says, "The fatty
substances taken up by the portal vein, like those absorbed by
the 4acteals, do not at once enter the general circulation, but
pass first through the capillary system of the liver, thence they
are carried with the blood of the hepatic veins to the right side
of the heart, and subsequently through the capillary system of
the lungs. During the passing they become altered in character,
as above described, and lose for the most part the distinguishing
characteristics of oily matter before they have passed beyond the
pulmonary circulation. But as digestion proceeds an increasing
quantity of fatty matter finds its way by these two passages into
the blood; and a time at last arrives when the whole of the fat
so introduced into the blood is not destroyed in its passage
through the lungs. Its absorption at this time taking place
more rapidly than its decomposition, it begins to appear in mod-
erate quantity in the blood of the general circulation ; and lastly,
when the intestinal absorption is at its point of greatest activity,
it is found in considerable abundance throughout the entire vas-
cular system. At this period, some hours after the ingestion of
food rich in oleaginous matter, the blood of the general circula-
tion every where contains an abundance of fat derived from the

Writers on Physiology, 37

digestive processes. If blood be then drawn from the veins
or arteries in any part of the body, it will present the peculiar
appearance known as chylores, or milky blood. After the sepa-
ration of the clot the serum presents a milky appearance, and
the fatty substances which it contains rise to the top after a few
hours and cover its surface with a partially opaque and creamy-
looking pellicle. This appearance has occasionally been observed
in the human subject, particularly in bleeding in apoplectic at-
tacks occurring after a full meal, and has been mistaken in some
instances for a morbid phenomenon. It is, however, a perfectly
natural one, and depends simply on the rapid absorption at cer-
tain periods of digestion of oleaginous substance from the intes-
tines. It can be produced at will at any time in the day by
feeding him with fat meat and drawing blood six or eight hours
afterward from the carotid artery or jugular vein. This state
of things continues for a varying length of time, according to
the amount of oleaginous matter contained in the food/'

38 The LymphcUie System,

CHAPTBE IV.

The Lymphatic System.

It will be seen from the extract given at the conclusion of
the last chapter that ordinarily oils and fats coming from the
right side of the heart through the pulmonary artery disappear
in their passage through the lungs, and are not to be discovered
in the blood of the carotid artery, and that this condition of
things sometimes exists in health. Ordinarily all that portion
of the food which is converted into glucose before it is ab-
sorbed and carried to the liver is so changed by its passage
through that gland that sugar is not found in the hepatic veins;
but when it is considered how very large an amount of this form
of food passes through the liver, are we not permitted to suppose
that the occurrence of sugar in the blood of the hepatic veins
and ascending vena cava is a condition exactly similar to the
occurrence of oils and fats in the blood of the carotid and other
arteries? Dr. Dal ton says that these oils and fats may be seen
even in blood drawn from the veins. In both instances the oils
and fats and the sugar found in the blood have to go the round
of the circulation, perhaps many times, before they disappear or
are completely changed.

Physiologists speak of the intervals of digestion. Properly
speaking, there are no intervals of digestion. I here mean by
digestion the conversion of food into blood. After we take our
daily meals there is a time, longer or shorter, varying according
to conditions not here to be named, during which all the food is
absorbed or removed from the stomach and intestinal canals. In

The Lymphatic System. 39

that sense there are intervals, but after the food has entered
the veins and lacteals, digestion proper or the conversion of food
into blood has just fairly commenced. Trees and plants convert
inorganic matter into organic living forms. It is the labor of
their lives. All animals convert what we call food, whether it
be grasses, grain, fruit, or meat, into blood, and blood into living
tissue. In trees the wood of which the bodies consist remains
unchanged and continues to increase from year to year, so that
the rings of annual growth show unmistakably the age of the
tree. There are trees a hundred, perhaps a thousand, years old.
It is because, unlike the tides, physiologists suppose that con-
structive assimilation or the formations of tissues (in the sense
of Bichat), and disassimilation or the separation of eiFete matter
from the tissues, go on at one and the same time in an animal
body; that animal bodies are completely renewed, according to
Drs. Draper, Dalton, and others, in twenty days.

There is no explanation of hereditary and inherited diseases;
there is no explanation of a man being bitten by a maddog
to-day and having hydrophobia seven years afterward; there is
no explanation of insanity where a man or woman becomes
insane and continues in that condition from one to ten or more
years, who is again restored to perfect health, both bodily and
mental, and whose memory treasures up all forms of knowledge
acquired up to the time he or she became insane, if the doc-
trine of constructive and destructive metamorphosis of the whole
organism is eifected every twenty days or every twenty months
be true, as taught in all the schools.

Many years ago I was informed by a gentleman in Virginia,
engaged in a herring fishery, that sometimes they caught more fish
than they could salt and pack before they would spoil; that they
hauled out these surplus fish with all the fish offal into the
fields and fed them to their hogs; and that the flesh of the
hogs so fed, when made into pork and bacon, tasted so strong
of fish that many persons refused to eat it. The fish were
caught, I believe, in March and April, and yet the meat of th6
hogs which fed upon them, when killed six or eight months after-

40 The Lymphatic System,

ward, tasted of fish. According to all modern physiologists the
bodies of these hogs had been changed many times in those six
or eight months.

No physiologist who allows himself to think can suppose
that the food is converted into living organized forms before
it has been changed into blood. In the blood is to be found
every element of which the animal body is composed. In the
herbivora grasses and grains are converted into living organ-
ized animal forms, including adipose tissue and muscular flesh.
In them the change of grasses and grains into flesh may be con-
sidered more remarkable than in man, who lives in part upon
animal food. But there is no diflerence. In both there has been
an entire change or metamorphosis of food into blood. After
the food, under whatever form it may be absorbed, enters the
circulation it continues to be carried uninterruptedly to every
gland and tissue of the body. It passes and repasses, so far as
the glands are concerned, through the lungs, kidneys, spleen,
liver, etc. Whether there is any elective affinity determining cer-
tain substances in the blood to go rather to one gland than to
another — as, for instance, the kidneys and spleen — perhaps can
never be ascertained. I do not think the thing so altogether
improbable. Physiologists teach that so soon as the food is
absorbed it goes directly to form organized tissues, muscles,
bones, etc. I say that they do not sufficiently recognize the fact
that the food has to be subjected to the action of every gland in
the body (except those concerned in reproduction) before it is
converted into blood. I teach that after the blood has been
thus formed it goes to make up the tissues of the body, organ-
ized forms, from conception till full growth, and that during this
period, if the individual remains in perfect health, the law of
constructive assimilation has alone been at work; that the ex-
creta thrown from the body during this period are made up of
that portion of the food which was not changed into muscles,
bones, etc.

We have now followed the food from the stomach to the left
side of the heart. It has been clearly stated that one form of

The Lymphatic System, 41

food, the oily, is often found in the blood of the arteries and
veins in all parts of the body. I believe, and I can not see how
it can be controverted, that the albuminose and glucose forms of
food also reach the left side of the heart and are sent along with
the arterial blood to all parts of the body before they are com-
pletely changed into white blood corpuscles, lymph corpuscles,
and red blood corpuscles. This brings us to consider the part
performed by the lymphatics upon these three forms of food.

We copy literally from Flint's Physiology what immediately
follows on the lymphatic system: "In 1649 Pequet discovered
the receptaculum chyli, and demonstrated that the lacteals did
not pass to the liver, but emptied the chyle into the commence-
ment of the thoracic duct, by which it was finally conveyed into
the system. In 1650-51 the anatomical history of the absorbent
vessels was completed by the discovery by Rudbeck of vessels car-
rying a colorless fluid in the liver and finally in all parts of the
body. Rudbeck demonstrated the anatomical identity of these
vessels with the lacteals. They were afterward carefully studied
by Bartholimus, who gave them the name of lymphatics. Though
these vessels are very delicate and difficult to study, it is now
pretty generally admitted that they have no orifice at their origin
in the intestines and other parts, but are perfectly closed, and all
substances which are absorbed by them, enter by imbibition ; and
it is now known that the fatty portions of the food, reduced to a
very fine emulsion by the pancreatic juice, are absorbed by this
system of vessels, and that these are the only principles taken
up in great quantity. It is an important question to determine
whether the lacteals, in addition to their more important func-
tion, be not concerned in the absorption of drinks, the albumi-
noids, saline, and saccharine matter. Comparative analysis of
the lymph and chyle always shows in the latter fluid an excess of
albumen and fibrin. As we may reasonably suppose that during
the intervals of digestion the lacteals carry ordinary lymph, for
at this time the vessels are filled with a colorless, transparent
fluid having the general physical character of lymph, it is natural
to infer that the excess of albumen and fibrin in the white chyle

42 Tlie Lymphatic System.

is due to the absorption of albuminoids from trie intestinal canal.
What has just been stated regarding the absorption of albumi-
noids applies with equal force to the saccharine matter and inor-
ganic salts.^'

It is true that the products of the digestion of saccharine and
amylaceous matters are taken up mainly by the blood-vessels, but
a small quantity is also absorbed by the lacteals. There can be no
doubt that a small portion of the liquid taken as drink finds its
way into the circulation by the lacteals, though the greater part
passes directly into the blood-vessels. According to the esti-
mates of Dr. Dalton, deduced from his own observation upon
dogs, and the experiments of Colin upon horses, the total quan-
tity of lymph produced in the twenty-four hours in a man
weighing one hundred and forty pounds is from six to six and
one half pounds; and again, reasoning from experiments made
upon dogs eighteen hours after feeding, when the fluid, passing
up the thoracic duct, may be assumed to be pure unmixed lymph,
the total quantity alone produced in the twenty-four hours by
a man of ordinary weight would be between three and a half
and four pounds (3.864 pounds). Collard de Martigny found, in
comparing the quantity of fluid in the lymphatics of the neck
during digestion and absorption with the quantity they contained
soon after digestion was completed, that while digestion and ab-
sorption were going on actively the vessels of the neck contained
scarcely any fluid, but the quantity generally increased after these
processes were completed.

Composition of

Lymph from

A Cow.

Water,

.

.

964.0

Fibrin,

, ^

.

0.9

Albumen, .

.

.

28.0

Fatty matter, .

, ,

,

0.4

Chloride of sodium.

, ,

,

5.0

Carbonate, phosphate,

and sulphate

of soda,

, 1.2

Phosphate of lime,

.

.

0.5

Total,

,

,

1000.0

The analyses of the human lymph which seem to be the most

The Lymphatic System, 43

reliable, and in which the fluid was comparatively pure and
normal, are those of Gubler and Quevenne. Gubler and Que-
venne made elaborate analyses of the different specimens of the
fluid with the following results :

CoxMPosiTioN OF Human Lymph.

^ First Second

Analysis. Analysis.

^ater, . . . 939.87 934.77

Fibrin, . . . 0.56 0.63

Caseous matter with earthy phos-
phates and traces of iron, . 42.75 42.80

Fatty matter in second analysis

fusible at 102.3° F., . . 3.82 9.20

Hydro-alcoholic extract contain-
ing sugar and leaving after in-
cineration chloride of sodium
with the phosphate and car-
bonate of soda, . . 13.00 12.60
Total, . . 1000.00 1000.00

The above analyses show a much larger proportion of solid
constituents than was found by Lassaigne in the lymph of the
cow. It is evident, however, from a comparison of the analysis
of Gubler and Quevenne, that the composition of the lymph
even when it is unmixed with chyle, is subject to great variations.
The caseous matter given by Gubler and Quevenne is probably
equivalent to the albuminous matter of the chemists. The dis-
tinctive characters of the diflerent principles found in the lymph
do not demand extended consideration, inasmuch as most of
them have already been treated of in connection with the blood.
In comparing, however, the composition of the lymph and the
blood, we are at once struck with the great excess of solid con-
stituents in the latter fluid. In analyses of the serum of the
blood by Becquerel and Rodier the proportion of solid constit-
uents was ninety-two parts per thousand, while in the analyses
of the human lymph by Gubler and Quevenne the proportion
was from sixty to sixty -five parts per thousand; and in the
analysis of Lheritier, which gives the largest proportion of solid

44 The Lymphatic System,

matter, the propbrtion was between seventy-five and seventy-six
parts. In all analyses except those of Lheritier the organic
nitrogen ized compounds have been found to be very much less
in the lymph than in the blood. This is generally most marked
in the fibrin; but, as before stated, the proportion of all the
ingredients is quite variable. Lassaigne found in the lymph of
the cow that the quantity of the albumen is little less than one
half the proportion contained in the blood; but in most analyses
of the human lymph the proportion has been much less. The
albuminoid matter of the lymph, therefore, would seem to pos-
sess certain distinctive characters, but we know so little of the
functions of this fluid that it is impossible to assign to these sub-
stances any special physiological properties. Fatty matter has
generally been found more abundantly in the lymph than in the
blood ; but their proportion is even more variable than that of
the albuminoid substances. All of the constituents of the blood
exist in the lymph, the only diiference being in their relative
proportions. It is the same with the corpuscular elements; for
the so-called lymph corpuscles are identical with the leucocytes
of the blood, and the red disks frequently find tjheir way into the
lymphatics. Glucose has also been found in the lymph. Poise-
ville and Lefort found that the proportion of sugar was always
greater in the lymph than in the chyle. It has not been ascer-
tained how the sugar contained in the lymph takes its origin,
and its function in this situation is equally obscure. The pres-
ence of urea in considerable quantity in both the chyle and the
lymph has been determined by Wurtz; and it is thought by Ber-
nard that the lymph is the principal fluid, if not the only one,
by which this excrementitious substance is taken up from the
tissues. Though the urea always exists in the blood, its quantity
is less than in the lymph. The positive facts upon which to base
any precise ideas in regard to the general functions of the lymph
are not very numerous. From the composition of this fluid,
its mode of circulation, and the fact that it is being constantly
discharged into the blood, it would seem not to have an impor-
tant function in the active processes of nutrition. The experi-

The Lymphatie System, 45

ments of Collard de Martigny sustain this view, inasmuch as the
quantity and the proportion of the solid constituents of the
lymph were rather increased than diminished in animalg that
had been deprived of food for several days, while it is well
known that starvation impoverishes the blood. On the other
hand urea, which is one of the most important of the products
of destructive metamorphosis of the tissues, is undoubtedly
taken up by the lymphatics and conveyed in this fluid to the
blood. It remains now for future investigation to determine
whether other excrementitious principles may not be taken up
from the tissues in the same way — a question of great importance
in its relations to the mechanisms of excretions. What is posi-
tively known in regard to the functions of the lymph may be
summed up in a very few words. A great part of its constitu-
ents is evidently derived from the blood, and the relations of
these principles (fibrin, albumen, and the inorganic salts) to nutri-
tion, are not understood. The same may be said of sugar, also
a constant constituent of the lymph, the origin of which even
is not known."

Had physiologists considered that the office and functions of
the lymphatics are to assist the liver, the lungs, the skin, and the
kidneys in the conversion of the food into blood, they would not
have been so perplexed as to the uses and purposes of the lym-
phatic system in the animal economy. It will be observed that
Dr. Flint says that " all the constituents of the blood exist in
the lymph, the only diiference being in their relative propor-
tions." He also says that sugar and fatty emulsion are found in
the lymph. We have seen that after the food is absorbed from
the stomach and intestines and conveyed through the different
passages already referred to, to the left side of the heart, that it,
the food, has not yet become blood. It has still to be subjected
to the metamorphosis of the glands, of the skin, of the kidneys,
and of the spleen; but after the food in this condition has
reached the left side of the heart, it is conveyed along with a
volume of blood to all parts of the body and to parts in which
there are no glands, viz. to the muscles, bones, etc. Now the

46 ' The Lymphatic System,

lymphatics originate in all parts of the body to which the arte-
ries go, whether to glands or muscles and bones. Maintaining,
as I io, that the lymphatic system is a part of the wonderful
apparatus by which the food is converted into blood, I say that
the lymphatics imbibe the food still floating in the blood,
whether it be oily, saccharine, or albuminoid, and convey it to
the lymphatic glands, wherever they may be. It is acted upon
by those glands and then carried to the thoracic duct, or to the
left subclavian vein, and next poured into the vena cava. That
part of the food which is so taken up by the lymphatics from
the blood floating in the arteries has not yet become blood, nor
is it fitted to build up organized tissues.

The extracts taken from Dr. Flint's elaborate work do not
follow each other consecutively. I have given, I think, sufiicient
to show the received doctrines of the most distinguished physi-
ologists on the lymph and lymphatic system. The knowledge
of the lymphatic system, Dr. Flint himself being judge, does
not amount to much. As more than once repeated, I must again
call the attention of the thoughtful reader to what I have before
said, viz. that so soon as physiologists get the food into the
blood-vessels they seem to ignore it altogether, and then only
speak of the blood ; they seem to forget that the fatty emulsion,
the glucose, the albuminose, and the inorganic salts and water
with which they are intimately mixed may float in the blood for
an undetermined period, until they themselves are converted into
blood by glandular action. This has been the fruitful source of
the unintelligibility of the lymphatic system, and of the lymph,
its product. Except the uses of the lacteals, which take up the
fatty constituents of the food from the intestines by imbibition,
they really know nothing about it. Sugar and fatty matter have
been found in the lymph as well as in the blood. Physiologists
can not account for it. They can not tell how these two sub-
stances get into the lymph, and what they have to do there.
Albuminose, not being so easily detected, they say nothing more
about it after it gets into the portal vein, but after that only
speak of albumen. I say that oily and saccharine matters float-

The Lymphatic System. 47

ing in the arteries are taken up by the lymphatics. They also, no
doubt, act upon the nitrogenous form of food which has not been
completely metamorphosed when it first reaches the left side of
the heart. As a demonstration of the correctness of my views,
I call the attention of the reader to the observation of CoUard
de Martigny. He found, in comparing the quantity of fluid in
the lymphatics of the neck during digestion and absorption with
the quantity they contained soon after digestion was completed,
that while digestion and absorption were going on actively the
vessels of the neck contained scarcely any fluid, but the quantity
generally increased after these processes were completed. It will
be seen that while digestion, in the sense here referred to, is
going on, and indeed up to the time that all the food has been
absorbed and conveyed through the lacteals, through the liver,
and through the lungs to the left side of the heart, the lymphat-
ics remained inactive. The time for them to begin to work was
after the three forms of food, not yet entirely changed, had been
sent along with the arterial blood to all parts of the body. What
M. de Martigny observed in the lymphatics of the neck applies,
no doubt, to lymphatics in every other part of the body. Again,
Poisenille and Lefort found that the proportion of sugar was
always greater in the lymph than in the chyle. As the lacteals
take up tlie oily and not the saccharine form of food, and as
the three forms of food floating in the blood do not pass at all
through the lacteals, it can be readily seen how more sugar is to
be found in the lymph proper than in the chyle.

Dr. Flint, vol. 3, page 16, says, ^'Certain of the fluids are
formed by special organs, and have important functions to per-
form which do not involve their discharge from the organism.
These may be classed as the true secretions, and the most strik-
ing examples of them are the digestive fluids.'' And again, in
vol. 2, page 430, says, ^' In the general description of the lym-
phatic system, three sets of vessels are usually recognized — the
plexus, situated on the general surface; the deep vessels; and
those coming from the small intestines, ordinarily called lacteals.''
Lymphatic vessels are found in the largest nimiber in organs

48 The Lymphatic System,

to which large quantities of blood are sent in proportion to the
size of those organs or glands. They are compared by physi-
ologists to other secreting glandular organs; as, for instance,
to the glands distributed over the mucous surface of the small
intestines.

I believe that all who will consider their functions must agree
with me that they are secreting organs. That portion of the
lymphatic system known as the lacteals absorbs the chyle from
the intestinal canal. All other portions of the lymphatic system,
those distributed to the deep vessels and the plexus on the sur-
face, imbibe from the arteries which they accompany the thing
we call lymph. As lymph cont-ains every constituent of the
blood, and as the blood is undeniably formed from the food, how
can we avoid the conclusion that the lymph too is formed from
the food. It is simply one of the stages through which the food
passes in its transformation into blood. Dr. Flint, and all phys-
iologists, I believe, teaches that "the so-called lymph corpuscles
are identical with the leucocytes, or white blood corpuscles, and
the red disks frequently find their way into the lymphatics.*' I
agree with those physiologists who maintain that the lymph
corpuscles are the first forms of the red disks or blood cor-
puscles. Dr. Flint states that "the proportion of the solid
constituents of the lymph were rather increased than dimin-
ished in animals that had been deprived of food for several
days." I do not think that physiological laws are to be ex-
plained by pathological conditions; but in the case referred to
I think there may be an explanation in this — the lymphatics
following the arteries to every and all parts of the body,
exhaust from them the last elements of food contained in the
blood after the animal begins to suffer from the want of its
usual supply of food. As to the existence of urea in the
lymph, or in the blood of a man in perfect health, I deny the
fact, and I do not doubt that physiologists will come to agree
with me when they have made further examinations of both
of those fluids. But I can not consider that question in this
connection.

The Lymphatic System, - 49

The lymph is a secretion proper; but, unlike other secre-
tions, it is formed not from the blood but from the three forms
of food floating in the blood which had not been changed when
they reached the left side of the heart. All other secretions,
such as the saliva, the gastric, and pancreatic juices, are formed
directly from arterial blood. I consider the liver, the lungs, the
skin, and the kidneys as excretory organs; what they separate
from the food in transforming it into blood has to be thrown off
from the body.

The excretions will be considered in the next chapter.

In his concluding notices of the lymph. Dr. Flint says,
"From the composition of this fluid, its mode of circulation,
and the fact that it is being constantly discharged into the
blood, it would seem not to have an important function in the
active processes of nutrition." If the food becomes blood as
soon as it enters the circulation by some mystic catalytic pro-
cess, or if, without being turned into blood, it is transformed
into living organized tissues by simply passing through the
capillary system, as seems to be taught by Flint and Dalton,
the two great American physiologists, I could agree with them
that the lymph "had no important function in the active pro-
cesses of nutrition." But if the views which I have presented
above be correct, then it must be apparent to every reflecting
mind that the lymph performs a very important part in the pro-
cesses of nutrition. The quantity of the lymph is admitted to
be large; this large quantity is poured into the vena cava just
before that great vessel empties itself into the right side of the
heart. ^

What is immediately about to take place? The venous blood
will immediately lose a large part of its constituents — carbonic
acid — in its passage through the lungs. It also loses a large
amount of watery vapor, carrying off with it perhaps some inor-
ganic salts. The lymph, rich in albumen, fibrin, and lymph cor-
puscles, comes to supply this loss. The large amount of fluid
poured into the blood from the great lymphatic vessels may sup-
ply the loss in the lungs thrown off as watery vapor. I do not

4

50 The Lymphatic System,

here consider the offices of the lymphatics when the human body-
is in a pathological state.

There is another organ which acts upon the food after it
reaches the left side of the heart, which organ has no excretory
duct. I refer to the spleen. Many volumes have been written
upon the functions of this gland. That organ, for the size of it,
is supplied with a very large quantity of arterial blood. The
albumen and fibrin found in the blood of the veins coming from
the spleen are much larger in amount than the quantity of those
elements found in the arterial blood entering that gland. Dr.
Flint says, ^' Both Beclard and Gray observed a marked increase
in the fibrin and albumen in the splenic vein.^' I do not think
that this fact is contradicted by any physiologist. As I can not
believe that the catalytic change which converts food into blood
takes place in the blood-vessels, I maintain that one of the func-
tions of the spleen is to convert the albuminose of the food into
fibrin and albumen. From what other source can this increased
quantity of albumen and fibrin have come than from the food in
the form of albuminose contained in the blood passing through
the spleen? The spleen is continually pouring rejuvenated blood
into the portal vein. It is because physiologists have not consid-
ered that glucose, fatty emulsion, and albuminose are not blood,
and do not become blood in the circulatory system, but have to
be subjected to the action of secretory glandular organs to con-
vert them altogether into blood, that they have been unable to
understand the physiological uses and offices of the spleen. Phys-
iologists have seemed to marvel because the spleen is a ductless
gland. If my explanation of its functions is correct, no duct is
needed. Nothing is separated from the blood in its passage
through the spleen. The work which the spleen has to do is
to change certain elements of the food into albumen and fibrin.
But it will be said that animals not only live but thrive after
the spleen is taken out of their bodies. I doubt that they thrive
much. This only shows the wonderful provision which Nature
has made for such accidents, whether caused by sickness or the
vivisection of experimenters. In some fever and ague countries

!Z%e Lymphatic System, 51

the spleen sometimes becomes so much enlarged that it is unable
to perform any physiological function. In such cases, or where
the spleen is removed, other organs convert the food into albu-
men and fibrin. In perfect health, other glands contribute to
that end.

The portal veins have no valves. The lymphatics have
valves.

52 The Excretions,

CHAPTER V.

The Excbetions.

We copy from Flint's Physiology : " Certain other of the fluids
are composed of water holding in solution one or more charac-
teristic principles which result from the physiological waste of
the tissues. The principles have no functions to perform in the
animal economy, and are simply separated from the blood to be
discharged from the body. These may be classed as excretions,
the urine being the type of fluids of this class/' (Vol. 3, p. 16.)

"All the remarks, indeed, that have been made concerning
excretions in general may be applied without reserve to the
action of the kidneys; and there are few subjects in physiology
of greater interest than the process of urinary secretion, with its
relations to nutrition and disassimilation.'' (Vol. 3, page 144.)

" The striking peculiarities which the kidney presents in its
structure, as compared with the true glands, and the fact of the
voluntary discharge of its secretion at certain intervals, would
naturally lead to a close study of the mechanism of the forma-
tion of the excretions. The composition of the urine also will
be found exceedingly complex, and its various ingredients bear
the closest relation to the process of nutrition and disassimila-
tion, all of which considerations render it of the greatest impor-
tance to ascertain the precise mode of its formation, and to study
all the conditions by ^vhich this process may be modified. In the
present state of our knowledge, we must certainly regard the
excrementitious constituents of the urine as formed essentially in
the system at large and merely separated from the blood by the
kidneys, and a consideration of these effete principles belongs to

The Excretions, 53

the subject of nutrition. It remains for us, then, in this con-
nection to treat in general terms of the way in which these
substances find their way into the urine. The most important
constituent of the urine is urea, a crystallizable, nitrogenized
substance which is discharged by the skin as well as by the kid-
neys. This has long been recognized as an excrementitious
principle, but the first observation which gave any definite idea
of the mechanism of its production was presented by Prevost
and Dumas in 1821. Since that time, as the processes for the
determination of urea in the animal fluids have been improved,
this substance has been detected in minute quantity in the nor-
mal blood by Marchand, Picard, Porsenille, Gobley, and many
others. Picard, indeed, carefully estimated and compared the
proportions of urea in the renal artery and the renal vein, and
found that the quantity in the blood was diminished about one
half in its passage through the kidneys. According to Robin,
who apparently accepts the results obtained by Picard, the blood
in the renal vein contains much less urea, urates, creatin, crea-
tinin, chloride of sodium, etc. than the blood of the renal artery.
Still later urea has been found by Wurtz to exist in the lymph
and chyle in larger quantity than even in the blood.

"These facts, which have been almost universally regarded
as established, have led physiologists to adopt the view that the
peculiar excrementitious principles found in the urine are not
produced by the kidneys, but are formed in the system by the
general process of disassimilation, are taken up from the tissues
by the blood, either directly or through the lymph, and are
merely separated from the blood in the kidneys ; and it has con-
sequently been pretty generally assumed that nearly, if not all,
the constituents of the urine preexist in the circulatory fluid.
There is indeed no well-defined principle in the urine that has
not been demonstrated in the blood. As an accidental argument
in favor of this view of the mechanism of urinary excretion, it
has been ascertained that when the kidneys have been inter-
rupted in their function there is a tendency to the elimination
of the excrementitious principles of the urine by the lungs, skin,

54 The Excretions.

and alimentary canal, and that these matters only accumulate in
the blood after this vicarious effort has failed to effect their com-
plete discharge/' (Flint, vol. 3, page 165.)

In Flint's Physiology, vol. 2, page 528, he says, " One of the
most important physiological facts in the chemical history of
the lymph is the constant existence of a considerable portion of
urea. This can not be derived from the blood, for its proportion
is greater in the lymph, notwithstanding that this fluid is being
constantly discharged into the blood-vessels. The urea which
exists in the lymph is derived from the tissues; it is discharged
then into the blood, and is constantly being removed from this
fluid by the kidneys." That urea, the nitrogenized principle
found in the largest quantity in the urine, is an excrementitious
substance none will deny, but that the urea which exists in the
lymph is derived from the tissues, I deny. It ought to be a suf-
ficient answer to this assumption, for it is the merest assumption,
growing out of a total ignorance of the laws of the animal econ-
omy; it ought, I repeat, to be sufficient to state the fact that
urea does not exist in any living tissue found in the human body
when the individual is in perfect health. Effete matter, as such,
results from the disintegration, disassimilation, or destructive
metamorphosis, call it which you please, of living, organized
tissue. The process is accomplished by the capillary vessels.
Arterial blood is carried to them in every part of the body.
The veins do not make, but they receive, a different fluid con-
veyed into them by the capillaries. This different fluid is the
blood changed by its passage through these last-named vessels.
It is changed or rendered darker in color by the addition of
effete matter eliminated in the capillaries. It may be effete
blood. In health, when the individual is grown and remains
about the same average weight, there is little or no addition to
or subtraction from the organized living parts of the body. In
sickness, where a man is decreasing in weight daily, the process
of disassimilation is actively going on, and the venous blood is
charged with a larger amount of effete matter. But, in whatever
way it may be separated from the living organism, it is always

The Excretions, 55

made up of constituent parts of that organism. Urea, while an
excrementitious principle, is also a secretion. Dr. Flint says it
can not be derived from the blood because it exists in the lymph
in larger quantities ; and again, that the urea which exists in the
lymph is derived from the tissues. I wish the reader to note
well this last expression. Dr. Flint does not say, nor does anv
physiologist say, how it is derived from the tissues. I have
quoted sufficiently to show the doctrines taught on the subject
by the highest authorities. I fully agree with Dr. Flint in the
importance he attaches to a correct understanding of the excre-
tions and of the method by which the urine is formed, which
fluid, he says, is a type of them. Dr. Flint says that urea has
been detected in minute quantities in the normal blood by many
distinguished physiologists. By normal blood I suppose he
means the pure arterial blood of a healthy man. If, as he
teaches, and all physiologists to whom he refers teach, urea is
the product of destructive matamorphosis, and is created or
formed by some process in the act of separation of the solid
constituents of the organism, then it not only ought to be found
in minute quantities but it ought also to be found in large quan-
tities in the normal blood. If it is ever a constituent part of
the normal blood of a healthy man it is a constant quantity, and
must always be found there. We will see presently whether it
is a constant quantity in healthy blood.

The doctrine taught by physiologists involves the necessity
for and the truth of another doctrine, viz. that constructive as-
similation and destructive metamorphosis are continually going
on in the animal body at the same time. If a man consumes
three or ten pounds of food and drinks daily, that quantity is
added to the solid organism, and the like amount is separated
from the organism by destructive metamorphosis, and they cor-
rectly call the thing so separated effete matter. Urea, they say,
is a constituent part of effete matter. Dr. Dalton says, "The
quantity of urea produced and discharged daily by a healthy
adult is, acccording to the experiments of Lehman, about five
hundred grains. It varies to some extent like all the other

56 The Excretions,

secreted and excreted products with the size and development
of the body. Lehman, in experiments on his own body, found
the average daily quantity to be four hundred and eighty-seven
grains. Professor William A. Hammond, who is a very large
man, by similar experiments, found it to be six hundred and
seventy grains. Dr. John C. Draper found it to be four hun-
dred and eight grains. The three individuals named were, I
take it, in good health, as nothing is said to the contrary. These
quantities of urea, relative in proportion to the size of the body,
must be emptied into the blood of every healthy man during
every twenty-four hours, according to the doctrine taught by
physiologists. It is, according to them, one of the forms of
effete matter. This effete matter is being constantly separated
from the solid organism of healthy individuals, according to their
teaching. It is then, I again affirm, a constant quantity of the
normal blood.

I do not see how physiologists can avoid this conclusion.
How, I would like to know, do they explain what they assume
to be a fact, that urea is found in minute quantities in the normal
blood ? It exists, necessarily according to their teaching, in very
large quantities. Why then do they not always find it in large
quantities in the blood ? This is no idle question. Physiologists
are compelled to answer it or acknowledge that they are alto-
gether mistaken as to the origin of urea. According to the
three observations just given, there were discharged from the
bladder, in one instance, five hundred grains of urea; in another,
six hundred and seventy grains; and the last, four hundred and
eight grains. Now, according to the doctrine taught by physi-
ologists, these several large quantities of urea existed in the
blood of healthy men ; it was a part of effete matter separated
from the tissues, the functions of the kidneys being only to sep-
arate the urea from the blood. M. Claude Bernard and some
other experimenters admit that they could not find urea in the
blood of dogs from whom the kidneys had been removed, some-
times for twenty-four hours and sometimes for forty-eight hours
after the removal of thosia organs. Destructive metamorphosis

The Excretions, 57

was no doubt certainly going on in the entire organism of those
dogs so mutilated, and a large amount of eifete matter must have
been emptied into the blood. Urea, they say, is not only a con-
stituent part of eifete matter, but a very large part of it. Why
then, I ask, did they not find it in the blood of those dogs? The
kidneys, they say, separate urea from arterial blood brought to
them by the renal arteries. These glands do not, according to
their theory, generate or create urea from the blood, but only
separate it as a compound entity which preexisted in the blood
before that fluid entered the kidneys. According to their teach-
ing the quantity of urea in the blood must have begun to accu-
mulate immediately after the kidneys were taken out of the
bodies of the dogs, for they were the glands, the especial func-
tion of which was to eliminate urea from the blood. Not only
common sense but inexorable logic compels them to explain the
dilemma in which they find themselves or to admit that they are
entirely in error.

I will give another illustration to show that after the ad-
ministration of a particular drug no urea can be found in the
blood. I refer to colchicum. In the Monthly Journal of Med-
ical Sciences for January, 1852, page 21, in a paper by Dr. J. M.
Maclagan, of Edinburgh, on the Effects of Colchicum, we find
the following: '^ The first case was that of a girl under Dr.
Wright's care in the Eoyal Infirmary. On the 13th of October
a small quantity of blood was abstracted, analyzed, and found to
contain in

" 1000 parts of blood,

•

0.507

urea.

1000 "

•

.864

uric acid.

le urine was examined at the

same time.

It contained

"Total solids,

,

.

28.568

Water,

,

971.432

Urea,

,

10.496

Uric acid,

,

.257

Inorganic salts.

.

7.461

Organic matter,

• •

10.354
1000.000

Total,

28.568

58 The Excretions,

''Colchicura in combination with muriate of morphia was
then administered. The urine was again examined on the 18th
of October, being the fifth day. It contained:

''Total solids, . . . 31.459

Water, . . " . 968.541

Urea, . . . 12.312

Uric acid, . . . .421

Inorganic salts, . . 8.231

Organic matter, . . 10.495

Total, . . 1000.000 31.459

"The urine was again examined on the 22d of October, or
ninth day. It contained :

"Total solids, . . . 35.613

Water, . . . 964.387

Urea, . . . 13.984

Uric acid . , . .598

Inorganic salts, . . 9.401

Organic matter, . . 11.630

Total, . . 1000.000 35.613

"After twelve days' constant use of the colchicum, a small
quantity of blood was procured for examination. Now, however,
not the slightest trace of urea, or uric acid, could be detected in
so large a quantity as thirty-five hundred grains. The urine
was examined at the same time and found to contain :

''Total solids, . . . . 34.554

Water, . . . 965.446

Urea, . . ; 14.561

Uric acid, . . .737

Inorganic salts, . . 9.649

Organic matter, . . 9.607

Total, . . . 1000.000 34.554

"The colchicum being continued the urine contained on the
eighteenth day:

"Water, . . . 961.872

Urea, . . . 17.635

Uric acid, . . . 1.034

Inorganic salts, . • . 9.049

Organic matter, . . 9.607

Total, • . . 1000.000

The Excretions, 59

Dr. Maclagan does not give another case in which the blood
was examined after the administration of colchicum. I have no
doubt if I had access to recent medical books and journals, and
could examine them myself, I should find many cases confirma-
tory of the truth of Dr. Maclagan^s observations. I would call
attention to the fact observed by Dr. Maclagan, that the quan-
tity of urea in the urine was greatly increased after the admin-
istration of colchicum. In the case referred to 10.496 parts
of urea were found in one thousand parts of urine before the
administration of the drug. When the blood was examined* the
second time the quantity of urea in the urine was increased to
14.561 parts in one thousand parts of urine. And afterward the
urea was increased to over seventeen parts per thousand of urine
in this same patient. Now it will be observed in this case that
before the administration of colchicum half a grain of urea was
found in one thousand grains of blood; after the administration
of the drug not a trace of urea could be found in three thousand
five hundred parts of blood. If urea is a constituent part of
effete matter, if it is formec^ in some manner in the act of its
separation from the living organism, it must necessarily be a
constant quantity in the blood ; and seeing that under certain
circumstances or conditions, to be more particularly referred to
hereafter, the quantity of urea found in the urine is largely
increased, we must have under those conditions a corresponding
increased quantity of it in the blood. The case referred to by
Dr. Maclagan was the subject of rheumatism, and was not in
good health. So far as the secretions and the excretions are
concerned, I do not know that the laws of organic or vegetative
life in the higher orders of animals, as the ox, for instance,
differ from the same laws in the human animal, man. If urea is
formed from and by disintegration of living tissues, in the act of
waste and repair in the body of a man, it ought to be so formed
in the body of an ox. If I am not correct in this I would like
to be informed wherein the error consists.

Now we know that so long as a calf sucks a cow urea is
found in the urine; but so soon as the calf is weaned and

60 The Excretions,

feeds on grasses and grains, the urate of soda ceases to appear
in the urine, and in its place we find the hippurate of soda.
According to the theory of physiologists as to the formation
of urea, this can not be explained. The eifete matter formed
from the muscles, nerves, brain-substance, and bones of an
ox can not differ from the effete matter formed from the
same organized forms in a human body. There may be
more or less of any one constituent part of this effete matter,
but as a whole it must contain the same chemical substances.
The human infant, in one respect, is like the calf; so long as
the latter is nourished on animal food, milk, urea and urate
of soda are found in its urine. In new-born infants, and
for a short time after birth, no urea is found in their urine;
but in a very short time it appears in that fluid. What has hap-
pened during this short interval? Simply this, the child has
begun to suck, and it has to convert the mother's milk into
blood ; urea is one of the products of this conversion, just as it
was one of the products of the conversion of milk into blood in
the calf. But why is there no urea discharged from the bladder
of a new-born infant, or up to the time the child sucks? No
physiologist will pretend to say that the laws of secretion and
excretion in an infant a month old differ from the laws which
govern the vegetative life of an infant at birth. The laws of
constructive assimilation and destructive metamorphosis which,
they say, are continually and coexistingly at work, are then in
active operation, and according to their theory, a large amount
of effete matter containing urea must be constantly eliminated
from the body.

I have shown that under two conditions urea can not be
found in the blood. I have shown that under one condition
it is found in the urine of the herbivora, and that under
another condition it not only can not be found, but that it
does not exist in the urine; another substance, hippurate of
soda, taking its place. I have also shown that before a
human infant sucks, urea can not be found in its urine. I
think it is not an assumption in me to say that urea is not a

The Excretions. 61

coiistltuent part of healthy blood, and to affirm that it was never
found in the blood of a healthy man Avhose kidneys were perform-
ing their proper functions. If I am correct in this, it necessarily
follows that urea is not formed from, or out of, effete matter.
What applies to urea applies to all other organic forms found in
the urine. The kidneys, then, do not remove effete matter under
any form from the blood. This applies to men and women in
good health or in ordinary health. When the body is being wasted
by sickness or starvation, a pathological state, when no food is
taken for days, then the kidneys may form urea and the other
organic substances found in the urine from effete matter. But
this, I repeat, is a law of life under pathological, not physiolog-
ical, conditions. How then are the urea and the other organic
constituents found in the urine formed ? I answer that they are
one and all of them formed from the food. The urine contains
the same four classes of substances as does the food, viz. water,
nitrogenized substances, non-nitrogenized substances, and ashes.
It follows, then, that it can be formed out of the food. Dr.
Dalton says, ^' The quantity of urea varies also with the nature
of the food." Lehman, by experiments on his own person, found
that the quantity was larger when living exclusively on animal
food than when living on a mixed or vegetable diet; and that
the quantity was smallest when confined to a diet of purely
non-nitrogenous substances, as starch, sugar, and oil.

The following table gives the results of these experiments :

Kind of Food. Daily Quantity of Urea.

Animal food, . . . 728 grains.

Mixed food, . . . 487 "

Vegetable food, . . .337 "

Non-nitrogenous food, . . 231 "

It is not stated that in these experiments a less quantity of
mixed or purely vegetable food was eaten when so much less
urea was found in the urine, than of animal food when so large
a quantity was found. The reasonable supposition is that the
individuals ate enough to nourish and sustain their bodies, and
therefore they consumed more of mixed and vegetable food than

62 The Excretions,

they did of animal food. But physiologists teach that all the
food eaten, whether animal or vegetable, goes to form living
tissue, muscle, bone, nerve - substance, etc. before any of it is
eliminated from the body by the excretory organs. According
to them, the urea which is found in the urine was once a part of
the living organism. We know that every part of the animal
body can be formed from vegetable substances. This is con-
stantly exhibited in the bodies of the herbivora, and millions of
human beings who have well developed bodies live almost exclu-
sively on vegetable food. I have already shown that it can not
be formed by this disintegrating process, because it does not
exist in the urine of an ox or of a new-born infant, and that it
is only under particular circumstances, pathological conditions,
in which it can be detected in the human blood. Every read-
ing man is familiar with the dietetic habits of the Esquimaux.
According to Dr. Kane they eat from eight to ten pounds of
uncooked meat at a meal, and drink half a gallon of soup and
water daily. He saw one of these men eat at a meal ten pounds
of fresh meat. Can any one suppose that this enormous quantity
of food and drink is daily converted into organized living tissue,
and that it is all removed within the same short period of time
from the body as effete matter, and that urea and other nitro-
genized principles in corresponding quantities are produced in
that way ? The thing is absurd. The Esquimaux are said to be
men of moderate stature. If they weigh only one hundred and
forty pounds, they would, according to an estimate of Dr. Dal-
ton, given in a former part of these pages, have their whole
body made up of new walrus blubber every fourteen days. It
seems to me that animals or men so continually re-formed, and
that in so short a time, could have no strength ; and yet the
Esquimaux are said to be remarkably strong and active. They
require a large amount of food to keep their bodies warm in so
cold a climate. Animal heat in them is produced by the activity
of secretory and excretory processes, by which this large amount
of food and drink is converted into blood. No doubt they dis-
charge daily large amounts of urine, and this fluid contains, no

The Excretions, 63

doubt, very large quantities of urea and other organic constitu-
ents. I maintain that the kidneys are the organs, and the only
organs, which make or create urea and all other organic sub-
stances found in the urine. We have seen that under the influ-
ence of colchicum they are stimulated to form large quantities of
urea. Dr. Dalton says, ^^ The daily quantity of urea varies also
with the mental and bodily activity." It is a well-known fact
that certain mental conditions cause the kidneys to secrete urine
in large quantities. The action of that class of medicines known
as diuretics is another example of this. It all amounts to and
shows one thing, viz. that the kidneys, like the liver, can be
excited to increased or more vigorous action. It would be im-
possible to understand why physiologists are unwilling to admit
that the kidneys form or create all organic substances found in
the urine did we not know that the truth or soundness of an-
other theory, which is made to depend upon the assumption that
the kidneys simply separate effete matter under different forms
from the blood, rests upon the denial of this vital law. Urea is
found as a constant quantity of urine; under certain dietetic and
therapeutical conditions, this quantity is largely increased. Urea
is not found in the blood under certain conditions to which I have
referred. But urea is sometimes found in the blood in very minute
quantities. Physiologists have assumed that all effete matter is
thrown out of the system through three channels — the lungs, skin,
and kidneys. Except the cholesterin, they teach that the bile is an
incrementitious substance, and is constantly being reabsorbed.
The lungs throw off carbonic acid with watery vapor, with per-
haps some other substances under particular conditions not neces-
sary to be named here. The skin throws off from the body a very
small fraction of solid matter, being about five parts in a thousand.
It remains then as a necessity, according to their theory, for the
kidneys to remove from the blood a very large amount of the
effete matter, which is thrown off from the body daily. Physiol-
ogists having also assumed that all the food, after its absorption
from the stomach and bowels, is transformed into living tissue
before any of it is removed as effete matter, they are shut up to

64 The Excretions,

the necessity of affirming that nearly all of the effete matter is
removed from the body by and through the kidneys. This last
assumption is made to depend upon another, viz. that the body
of a man weighing one hundred and forty pounds is entirely
re-formed in twenty days according to some, and in a few months
according to others. Urea having sometimes been found in the
blood of a man in ordinary health, and also in the neighborhood
of certain tissues, they argue that it is formed or created some-
where or somehow in different parts of the body, and that the
only office of the kidneys is to remove it and other compound
substances from the blood.

As I will discuss this subject again under another head, I will
only here repeat. I affirm, first, that the kidneys by glandular
and catalytic action form urine and all its constituent parts from
the food floating in the blood ; that this is one of the processes
by which the food and drinks are converted into blood pre-
paratory to their assimilation into the organized forms of the
animal economy; that the compound substances, such as urea,
creatin, creatinin, etc. found in the urine are the necessary prod-
ucts of the vital action which prepares the food for the trans-
formation into muscle, bone, nerve, and brain- substance, and
all of the other organized forms of the animal body. I main-
tain, secondly, that the kidneys do not act upon and never
separate effete matter from the blood of a man while he is in
good health; and, as a consequence of this last proposition,
that urea, creatin, creatinin, etc. were never parts of the living
organism. This is the condition of things in health, and it
expresses a physiological action of the kidneys when construct-
ive assimilation alone is going on in the animal body. That the
kidneys may act upon effete matter when constructive assimila-
tion is not at work, but when from starvation or sickness no
food is eaten, and destructive metamorphosis is actively at work,
causing a loss of weight. I admit that the kidneys then act
upon the effete matter in the blood as they do upon medicinal
substances, such as the iodide and bromide of potash, etc. I
must now refer to this subject under another head.

The Excretions, 65

We are told that the urea exists in the lymph and chyle in
larger quantities than in the blood. In the extracts found in the
first part of this chapter Dr. Flint says, " These facts which
have led physiologists to adopt the view that the peculiar excre-
mentitious principles found in the urine are not produced by the
kidneys, but are formed in the system by the general process of
disassimilation, and are taken up from the tissues by the blood
either directly or through the lymph." Again, Dr. Flint says,
" One of the most important physiological facts in the chemical
history of the lymph is a constant existence of a considerable
portion of urea. This can not be derived from the blood, for its
proportion is greater in the lymph, notwithstanding that this
fluid is being constantly discharged into the blood-vessels. The
urea which exists in the lymph is derived from the tissues; it is
discharged then into the blood, and is constantly being removed
from this fluid by the kidneys." That urea is a constant quan-
tity of the urine, there can be no question. If it constantly
exists in the lymph, as Dr. Flint affirms, it must always be found
in the blood, unless it is eliminated from that fluid by the lungs,
which he does not teach or maintain. I have shown conclusively
that under several conditions urea can not be found in the blood.
I leave it to the physiologists to explain the dilemma in which
they find themselves.

But they teach that urea is also found in the chyle. At what
particular point in the chyliferous system they obtained the chyle
in which they found the urea, they do not state. If between the
mucous membrane of the intestinal canal and the mesenteric
glands, I would like for them to explain how the effete matter
got there, unless lymphatic vessels accompany the lacteals and
empty themselves into them, which nobody teaches. I very
much doubt the fact of urea being found in the chyle, but if my
doubt is not well founded, then this particular urea must some-
how be formed from the food, and not by any process of disas-
similation. Dr. Flint says, "Urea is taken from the tissues of
the blood either directly or through the lymph." My explana-
tion of the existence of urea in either the blood or the lymph is

5

66 The Excretions,

this : In certain pathological conditions, by some obstruction of
the uriniferous ducts which convey the urine after it is secreted to
the ureters, it sometimes happens that all the urea and other com-
pound soird substances are not emptied into those canals, but are
taken up by the venous absorbents and are emptied into the renal
veins ; just as in jaundice after the bile is secreted in the liver it
is not all conveyed into the hepatic duct, but is partly absorbed
by the veins and carried along through the hepatic vein to the
vena cava. That more urea should be found in the blood of the
renal artery than in the blood of the renal vein, I do not think
it difficult to explain, nor do I think it more difficult to explain
why more urea is found in the lymph than in the blood. The
urea which has escaped through the renal veins enters the gen-
eral circulation, arterial as well as venous. The lymphatics,
according to my belief, accompany the arteries to separate from
them, as their special physiological function, that portion of the
food which has entered the arterial blood ; this they convert into
albumen and fibrin. But they may also possess the power to
separate from the arterial blood any foreign or abnormal sub-
stance which may have gotten into it. Both of these functions,
I think, are performed in health before the arterial blood has
entered the capillaries. But another difficulty occurs. Agree-
ing fully with physiologists that more urea is found in the lymph
than in the blood, we know that the whole volume of the lymph
is being continually emptied into the right side of the heart, and
that therefore the urea found in it must be again mixed with the
general current of arterial blood. How then can we explain the
fact of a larger quantity of urea being found in the renal artery
than in the renal vein? I say that it escapes from the renal
vein in very small quantities. After a while the lymphatics
have separated it from the arterial blood and emptied it into the
right side of the heart through the larger lymphatic vessels;
then the law of elective affinity, to which I have once before
referred, causes the urea to go directly to the kidneys through the
renal arteries. We know that some forms of potash, the iodide,
perhaps the bromide, are found in the urine within twenty min-

^ The Excretions. 67

utes after they are swallowed. When the bromide of potash is
taken in twenty- or thirty-grain doses, one half of it is eliminated
from the blood and passes off with the urine in twenty-four
hours. Urea has been given as a medicine. Let it get into the
blood as it may, it is a foreign substance in the same sense that
the iodide and bromide of potash are foreign substances. If by
elective affinity or elective attraction the one goes directly to the
kidneys, I see no reason why the same cause may not determine
the other to go there. But there is perhaps another explanation.
The kidneys, like all other glands which secrete actively, are
abundantly supplied with lymphatic vessels. Seeing that they do
take up urea in other parts of the body and discharge it into the
larger lymphatic vessels, explain it as you may, it is only reason-
able to suppose that they perform the same office in the kidneys
when the ureters fail to receive all the urea and other compound
substances which had been secreted or formed by the glandular
action of those organs. There would be, in the case supposed, a
much larger amount of urea, turned from its natural channel,
found in the kidneys than in any other part of the body. I say
that the lymphatics distributed through the kidneys would take
it up, and that they would soon empty it into the thoracic duct.
Urea thus conveyed into the lymph would be immediately mixed
with the chyle as it is poured into the receptaculum chyli. Urea
so conveyed from the kidneys into the circulation would cause a
larger amount of it to be found in the blood of the renal artery
than is found in the blood of the renal vein. But let it be
understood that I deny that urea is a constituent part of or a
constant quantity in either the blood or lymph of a healthy man.
But urea is found in the blood some twenty-four or forty-eight
hours after the kidneys have been removed from the body of a
dog; and in the dogs experimented on it could not be found
until after the expiration of twenty-four or forty-eight hours.
This urea, I admit, was not formed in any manner by the kid-
neys. It could not be, for there were no kidneys to make it.
How then was it formed? Eecollect that it was not found in
the blood in the dogs experimented on for many hours after

68 The Excretions,

»

their mutilation. According to the theory which physiologists
so strenuously maintain, it must always exist in the blood;
indeed they say in so many words that they had detected it in
normal or healthy blood. They say also that the kidneys con-
stantly remove it from the blood. How then can they account
for its not accumulating in the blood after the kidneys had been
removed? I think it will puzzle them to answer this question.
I say that when the organs whose function it was to form urea
out of the blood had been removed from the body, some other
gland had to act vicariously for the kidneys. Physiologists say
that urea, under certain pathological conditions, is separated
from the blood and thrown out of the body by the skin, the
lungs, and the mucous surface of the alimentary canal ; but they
do not say that it is formed by the skin, lungs, or mucous mem-
brane. It is a thing which I will not pretend to explain. I will
only venture to conjecture that as the lymphatics have the power
to separate it from the blood, they may have the power, that is,
the lymphatic glands including the mesenteric glands, to form
it out of materials floating in the blood.

The kidneys are, in my opinion, as much concerned in san-
guification or the conversion of the food into blood as are any
other glands. We have seen that our food and drinks are largely
intermixed with the saliva and other juices. The kidneys re-
move a large portion of this watery intermixture. They also
take up certain solid constituents of the food, which they con-
vert into urea and other substances found in the urine. This
explains why the blood flowing from them through the renal
veins is purer than that brought to them by the renal arteries. It
is perhaps the purest blood in an animal body because it has been
subjected to the last elimination. In conditions of perfect health,
when the blood formed from the food is not converted into tis-
sues, then the kidneys, as well as the lymphatic glands, act upon
effete blood passing through them. In pathological conditions,
where effete matter is separated from the tissues, the kidneys and
the lymphatic glands act upon this effete matter and convert it
into urea and other solid substances.

The Excretions. 69

I will now consider the perspiration.

" In the fullest acceptation of the term, perspiration em-
braces the entire function of the skin as an excreting organ
and includes the exhalation of carbonic acid, as well as watery
vapor and organic matter. The office of the skin as an elimina-
tor is very important, but the quantity of excrementitious matter,
with the properties of which we are well acquainted, such as
carbonic acid and urea, thrown off from the general surface, is
small as compared with the amount exhaled by the lungs and kid-
neys. One of the well-known objects of cutaneous exhalation
is to keep down animal temperature by evapofration where there
is a tendency to too great development of heat by exercise or
from other causes. Physiological chemists have detected urea
and some other effete matters in the perspiration, but it is prob-
able that some volatile principles are eliminated by the general
surface which have thus far escaped observation." (Flint's Physi-
oldgy, pages 131-133.)

Here, again, we find that Dr. Flint classes urea and other
substances found in the perspiration as effete matter. By refer-
ring back the reader will see how large an amount of saliva,
gastric, pancreatic, and intestinal juices is mixed with the food
in addition to the water and other fluids we drink. He will also
notice the chemical constituents of the saliva, gastric, and intes-
tinal jmces. All of these are intimately mixed with the food.

Dr. Dalton, in his Physiology, page 307, says, "The daily
quantity of all the fluids thus secreted and reabsorbed during
twenty-four hours will enable us to illustrate the activity with
which endosmosis and exosmosis go on in the living body. In
the following table the quantities are all calculated for a man
weighing one hundred and forty pounds.

"Secreted and Eeabsorbed During Twenty-four Hours.
" Saliva, . 20.164 grains or 2.880 pounds.

Gastric juice, . 98.000 " 14.000 '*
Bile, . 16.940 " 2.420 "

Pancreatic juice, 13.104 " 1.872 "

Lymph, . 27.048 " 3.864 "

175.258 " 25.036 "

70 The Excretions.

"A little over twenty-five pounds, therefore, of the animal
fluids transude through the internal membranes and are restored
to the blood by reabsorption in the course of a single day. It
is by this process that the natural constitution of the parts,
though constantly changing, is still maintained in its normal
condition by the movement of the circulating flurds and the
incessant renovation of their nutritious materials."

All of these fluids are concerned, and that is their sole pur-
pose, in the conversion of our food and drinks into blood. It is
a wonderful work they have to perform. By an elective affinity,
bone, muscle, membrane, tissues of all sorts, nerve, and brain-
substance select from the blood that which is fitted to give them
strength and nourishment. But in thus preparing the food for
its wonderful uses, certain substances have to be removed from
it. This, in my opinion, is accomplished before the question of
effete matter can begin to be considered. That which is removed
from the body is called excretory matter ; but as before remarked
this excretory matter is removed by secretory action. I think
this applies as well to the skin as to the kidneys. In both in-
stances arterial blood is sent to those organs, viz. to the kidneys
and to the perspiratory glands.

Composition of the Perspiration.

Water, . . . . 995.00

Animal matters and lime, . . .10 '

Sulphates and substances soluble in water, 1.05
Chlorides of sodium and potassium and

spirit extract, . . . 2.40
Acetic acid, acetates, lactates, and alco-
holic extracts, , . . 1.45
Total, . . . 1000.00

It will be seen that nine hundred and ninety-five in a thou-
sand is water in the perspiration. According to Dr. Dal ton a
man of average size in good health loses about two pounds per
day by perspiratory action. But the quantity varies according to
the temperature, dryness, or moisture of the atmosphere, accord-
ing to the amount of exercise and labor, and also according to

The Excretions. • 71

the quantity of fluids drunk. Indeed there is perhaps no one
of the excretory functions more variable in different individuals
than that of the perspiratory action of the skin. I am speak-
ing of the question physiologically. As such, I say that perspi-
ration is a secretion, though it removes matter which is properly
called excretion. But there are some forms of disease in which
it can not be called a secretion. The night-sweats of consump-
tive patients, and in the profuse sweats during the collapse of
cholera, I think the process has ceased to be secretory and may
be called effusion, or simple pouring out of the watery parts
of the blood from the body. But the true physiological per-
spiration of a healthy man, I repeat again, is secretory action,
though performing an excretory function, the purpose, object,
or intent of which is to remove from the food a large part
of the fluids with which it has been mixed up in its trans-
formation into blood. In health effete matter never enters
it. Has any physiologist ever even alluded to the fact that per-
spiration is one of the forces or functions by which the food is
converted into blood; that it is one of the methods by which
the fluids which have been mixed up with the food are removed
from the body? Of course under the general term of food I
include water and other fluids drunk as well as solid substances
eaten. We frequently speak of an insensible perspiration; that
is, the normal, healthful state of the function when there is no
disturbing cause. In health, when profuse perspiration is the
consequence of severe exercise or hard labor, * or when it is
caused by the exposure of the individual to a high tempera-
ture, great thirst is produced. This can be only subdued by an
abundant supply of water. The excessive perspiration has disr
turbed the process of the conversion of food into blood, and the
water is needed to restore the due proportion of things. Even
insensible perspiration can not be arrested with impunity. Ex-
periments have been made upon different animals by covering
their bodies with a coat of varnish, and the experiments demon-
strated the fact that if all perspiratory action is stopped death
soon follows. This, in my opinion, is because the blood-making

72 The Excretions,

process — that is, the conversion of food into blood — is totally
arrested. The chemical laboratory of the animal body, so to
express it, is a wonderfully nice one. Fortunately for man, it
can bear up against many disturbing causes; but the sudden stop-
page of the functions of organic life is soon fatal. And what is
organic life? From birth to death it is nothing else but the
conversion of food into blood, and the conversion of blood into
the living organized elements of the body when constructive
assimilation is at work. During health, as before remarked, I
think very little effete matter is removed from the tissues. But
life is so variable; a man is well to-day and ailing to-morrow,
sometimes weighing a few ounces more, sometimes a few ounces
less ; so that for the most part some effete matter is being removed
from the tissues. This effete matter, in my opinion, is removed
from the blood in health by the lungs and liver. When a man is
sick effete matter plays a more important part. Many of the func-
tional disorders to which flesh is heir depend upon the irregular
or disturbed performance of the process of assimilation or de-
structive metamorphosis. The human body is capable of endur-
ing this sort of disturbance to a wonderful degree. Many an
individual goes through life a chronic sufferer, but yet he lives,
and sometimes lives to a good old age. But not so with the pro-
cess of digestion — of the conversion of the food into blood.
Arrest this, and death is soon the inevitable consequence. This
is the light in which I consider perspiration. I think that many
important therapeutical consequences follow my interpretation of
this law of nature.

I have thus briefly referred to the excretory functions of three
organs — the liver, the skin, and the kidneys. These excretions
are removed from the food before it becomes blood, or in the
processes by which it is converted into blood. I have not yet
referred to the excretory functions of the liver when that organ
is acting upon effete matter. But there is another result of these
and the other glandular actions which are concerned in the con-
version of food into blood — this is the production of animal heat.

Animal Heat. 73

CHAPTER VI.

Animal Heat.

I now copy extensively from standard authors, that the gen-
eral reader may understand clearly and distinctly what they teach
as to the production of animal heat. We copy first from Dr.
Dalton: "According to Lavoisier, the oxygen taken into the
lungs was supposed to combine immediately with the carbonic
acid and to be at once returned under that form to the atmos-
phere ; the same quantity of heat resulting from the above pro-
cess as would have been produced by the oxidation of a similar
quantity of carbon in wood or coal. Accordingly he regarded
the lungs as a sort of stove or furnace by which the rest of the
body was warmed through the medium of the circulatory fluid."
" It was soon found, however, that this view was altogether erro-
neous ; for the slightest examination shows that the lungs are not
perceptibly warmer than the rest of the body ; and that the heat-
producing power, whatever it may be, does not reside exclusively
in the pulmonary tissue. Furthermore, subsequent investiga-
tions showed the following very important facts, which we have
already mentioned, viz. that the carbonic acid is not formed in
the lungs, but exists in the blood before its arrival in the pulmo-
nary capillaries ; and that the oxygen of the inspired air, so far
from combining with the carbon in the lungs, is taken up in solu-
tion by the blood globules and carried away by the current of the
general circulation. It is evident, therefore, that the oxidation
or combustion of the blood, must take place, if at all, not in the
lungs, but in the capillaries of the various organs and tissues of

74 Animal Heat

the body. Liebig accordingly adopted Lavoisier's theory of the
production of animal heat with the above modification. He
believed the heat of the animal body to be produced by the oxi-
dation or combustion of certain elements of the food while still
circulating in the blood; these substances being converted into
carbonic acid and water by the oxidation of their carbon and
hydrogen, and immediately expelled from the body without ever
having formed a part of the solid tissues. He therefore divided
the food into two different classes of alimentary substances, viz:
1. The nitrogenous or plastic elements which are introduced in
comparatively small quantity, and which are to be actually con-
verted into the substance of the tissues, such as albumen, muscu-
lar flesh, etc. ; 2. The hydrocarbons or respiratory elements, such
as sugar, starch, and fat, which, according to his view, are taken
into the blood simply to be burned, never being assimilated or
converted into the tissues, but only oxidized in the circulation,
and immediately expelled, as above, under the forms of carbonic
acid and water. He therefore regarded these elements of the
food as so much fuel, destined simply to maintain the heat of the
body, but taking no part in the proper function of nutrition."

Objections to this theory :

" First. It is not at all necessary to regard the evolution of
heat as dependent solely on direct oxidation. This is only one
of its sources, as we constantly see in external nature.

"Second. In vegetables there is an internal production of heat
as well as in animals ; a fact which has been fully demonstrated by
the experiments of Dutrochet and others, already described. In
vegetables, however, the absorption of oxygen and exhalation of
carbonic acid do not take place, excepting to some extent, during
the night. On the contrary, the diurnal process in vegetables, it is
well known, is exactly the reverse of this. Under the influence of
the solar light they absorb carbonic acid and exhale oxygen. And
it is exceedingly remarkable that in Dutrochet's experiments he
found that the evolution of heat in plants was always accom-
panied by the disappearance of carbonic acid and the exhalation
of oxygen. Plants, which in the daylight exhale oxygen and

Animal Heat 75

evolve heat, if placed in the dark immediately begin to absorb
oxygen and exliale carbonic acid, and, at the same time, the evo-
lution of heat is suspended. Dutrochet even found that the evolu-
tion of heat by plants presented a regular diurnal variation, and
that its maximum of intensity was about the middle of the day,
just at the time when the absorption of carbonic acid and the
exhalation of oxygen are going on with the greatest activity. The
proper heat of plants, therefore, can not be the result of oxida-
tion or combustion, but must be dependent upon a different
process.

" Third. In animals the quantities of oxygen absorbed and of
carbonic acid exhaled do not correspond with each other. Most
frequently a certain amount of oxygen disappears in the body
over and above that which is returned in the breath under the
form of carbonic acid. This overplus of oxygen has been said
to unite with the hydrogen of the blood, so as to form water,
which also passes out by the lungs; but this is a pure assumption
resting on no direct evidence, for we have no experimental proof
that any more watery vapor is exhaled from the lungs than is
supplied by the fluids taken into the stomach. It is superfluous,
therefore, to state that any of it is produced by the oxidation of
hydrogen. Furthermore, the proportion of overplus oxygen
which disappears in the body, besides that which is exhaled in
the carbonic acid in the breath, varies greatly in the same animal,
according to the quality of the food. Regnault and Reiset found
that in dogs fed on meat the oxygen which reappeared under the
form of carbonic acid was only seventy-five per cent of the whole
quantity absorbed, while in dogs fed on vegetable substances it
amounted to over ninety per cent. In some instances where the
animals (rabbits and fowls) were fed on bread and grain exclu-
sively, the proportion of expired oxygen amounted to one hun-
dred and one, or even one hundred and two, per cent ; that is,
more oxygen was actually contained in the carbonic acid exhaled
than had been absorbed from the atmosphere in a free state. A
portion of the carbonic acid, at least, must therefore have been
produced by other means than direct oxidation.

76 Animal Heat

" Fourth. It has already been shown in a previous chapter that
the carbonic acid which is exhaled from the lungs is not prima-
rily formed in the blood, but makes its appearance in the sub-
stance of the tissues themselves ; and furthermore, that even here
it does not originate by direct oxidation, but rather by a process
of decomposition similar to that by which it is produced from
su^ar in its alcoholic fermentation. We understand from this
how to explain the singular fact alluded to in the last paragraph,
viz. the abundant production of carbonic acid under some cir-
cumstances with a comparatively small supply of oxygen. The
statement made by Liebig, therefore, that starchy and oily mat-
ters taken with the food are immediately oxidized in the circu-
lation without ever being assimilated by the tissues, is without
foundation. It never, in fact, rested on any other ground than
a supposed probability ; and as we see that carbonic acid is abun-
dantly produced in the body by other means, we have no longer
any reason for assuming without evidence the existence of a com-
bustive process in the blood.

" Fifth. The evolution of heat in the animal body is not gen-
eral, as it would be if it resulted from a combustion of the
blood, but local, since it takes place primarily in the substance
of the tissues themselves. Various causes will therefore produce
a local deviation or depression of temperature by modifying the
nutritive changes which take place in the tissues. Local inflam-
mations increase very sensibly the temperature of the part in
which they are seated, while that of the general mass of the
blood is not altered. Finally, it has been demonstrated by Ber-
nard that in the natural state of the system there is a marked
difference in the temperature of the different organs and of the
blood returning from them. The method adopted by this experi-
menter was to introduce into the living animal the bulb of a fine
thermometer, successively into the blood-vessels entering and
those leaving the various internal .organs. The difference in
temperature in these two situations showed whether the blood
had lost or gained in heat while traversing the capillaries of
the organ. Bernard found, in the first place, that the blood, in

Animal Heat 77

passing through the lungs, so far from increasing was absolutely
diminished in temperature, the blood on the left side of the
heart being sometimes a little more, sometimes a little less, than
one third of a degree F. lower than on' the right side. The slight
cooling of the blood in the lungs is owing simply to its expos-
ure to the air through the pulmonary membrane and to the
vaporization of water which takes place in those organs. In
the abdominal viscera, on the contrary, the blood is increased in
temperature. It is sensibly warmer in the portal vein than in
the aorta, and very considerably warmer in the hepatic veins than
in the portal or vena cava. The blood in the hepatic veins is, in
fact, warmer than that of any other part of the body. The pro-
duction of heat, therefore, according to Bernard^s observations,
is more active in the liver than in any other portion of the sys-
tem. As the chemical processes of nutrition are necessarily dif-
ferent in the different tissues and organs, it is easy to understand
why a specific amount of heat should be produced in each of
them. A similar fact, it will be recollected, was noticed by De-
trochet in regard to the different parts of the vegetable organism.

"Sixth. Animal heat has been supposed to stand in a special
relation to the production of carbonic acid, because in warm-
blooded animals the respiratory process is more active than in
those of a lower temperature, and because in the same animal
an increase or diminution of the evolution of heat is accom-
panied by a corresponding increase or diminution in the prod-
ucts of respiration. But this is true of all other excretory prod-
ucts of the body. An elevation of temperature is accompanied
by an increased activity of all the nutritive processes. Not only
carbonic acid but the ingredients of the urine and the perspira-
tion are discharged in larger quantity than usual. An increased
supply of food is also required, as well as a larger quantity of
oxygen ; and the digestive and secretory processes both go on aj;
the same time with unusual activity.

" Animal heat, then, is a phenomenon which results from the
simultaneous activity of many different processes taking place in
many different organs, and dependent undoubtedly on different

78 Animal Heat.

chemical changes in each one. The introduction of oxygen and
the exhalation of carbonic acid have no direct connection with
each other, but are only the beginning and ending of a large
series of changes in which all the tissues of the body succes-
sively or simultaneously take part. Their relation is precisely
that which exists between the food introduced into the stomach
and the urine discharged by the kidneys. The kidneys require
for their nutrition a constant supply of solid and liquid food,
which is introduced through the lungs. The disintegration and
decomposition of the tissues give rise, on the one hand, to urea,
uric acid, etc., which are discharged with the urine, and, on the
other hand, to carbonic acid, which is exhaled from the lungs.''

Dr. Flint, vol. 3, page 423, says, "What is the relation to
calorification of those processes of nutrition which involve the
consumption of nitrogenized matter and the production of nitro-
genized excrementitious principles?"

"We can not study these phenomena alone, isolated from other
acts of nutrition. We may confine an animal to a purely nitro-
genized diet, and the heat of the body will be maintained at the
proper standard, but at all other times there is a certain quantity
of non-nitrogenized matter (sugar and, perhaps, fat) produced in
the system, which is only formed to be consumed. We may
starve an animal, and the temperature will not fall to any great
extent until a short time before death. Here we may suppose
that the process of deposition of nutritive matter in the tissues
from the blood is inconsiderable as compared with the transfor-
mation of the substance of these tissues into effete matter; and
it is almost certain that non-nitrogenized matter is not produced
in the organism in quantity sufficient to account by its destruc-
tion in the lungs for the carbonic acid exhaled. It seems beyond
question that there must be heat evolved in the body by the
oxidization of nitrogenized matter. When the daily amount of
food is largely increased for the purpose of generating the
immense amount of heat required in excessively cold climates,
the nitrogenized mattery are taken in greater quantity as well
as the fats, although their increase is not in the same proportion.

Animal Heat, 79

When, however, we endeavor to assign to nitrogenized matters
a definite proportion of heat-producing power, we are arrested
by a want of positive knowledge with regard to the metamor-
phoses which these principles undergo, and it is equally impos-
sible to fix the relative calorific value of the deposition of new
material in repair of the tissues and the change of their sub-
stance into effete material by disassimilation."

" From these facts, and other considerations that have already
been fully discussed under different heads, it is evident that the
physiological metamorphoses of nitrogenized matter bear a cer-
tain share in the production of animal heat, although, in connec-
tion with inorganic matter, their chief function seems to be the
repair of the tissues endowed with the so-called vital properties."

As far as the destination of amylaceous, saccharine, and fatty
matter of the food is concerned, Ave only know that they are inca-
pable of themselves of repairing muscular tissue, and that they
can not sustain life. They are never discharged from the body
in health in the form under which they enter, but are in part
or completely destroyed in nutrition. They are completely de-
stroyed in persons who, from habitual muscular exercise, have
very little adipose tissue. When their quantity in the food is
large they are of necessity entirely consumed, but may be depos-
ited in the form of adipose tissue. This, however, may be made
to disappear by violent exercise or under an insufficient diet.

There can be no doubt that the non-nitrogenized class of ali-
mentary principles is craved by the system in long-continued
exposure to extreme cold. This is particularly marked with re-
gard to the fats. In all cold climates fat is a most important
article of food ; and in excessively cold regions, while the nitro-
genized elements are largely increased, there is a very much
larger proportional increase in the quantity of fat. These facts
are very significant. If the non-nitrogenized elements of food —
which are not always indispensable, though very often necessary
articles — do not form tissue, are not discharged from the body,
and are consumed in some of the processes of nutrition, it would
seem that this change must involve the production of carbonic

80 Animal Heat

acid /perhaps also of water, and the evolution of heat. It is so
difficult to ascertain the exact quantities of carbonic acid, watery
vapor, etc. thrown off by the lungs, skin, and other emunctories,
and to estimate the exact amount of heat produced and lost, that
it is not surprising that calculations of the calorific power of
different articles of food should be frequently erroneous, particu-
larly as we have no means of knowing the exact calorific value
of the nitrogenized principles."

"Though we may assume that the non-nitrogenized elements
of food are particularly important in the production of animal
heat, and that they are not concerned in the repair of tissue, it
must be remembered that the animal temperature may be kept
at the proper standard upon an exclusively nitrogenized diet,
and we can not indeed connect calorification exclusively with
the consumption of any single class of principles, nor with any
single one of the acts of nutrition."

The extracts given above show, I think, clearly and distinctly,
the views entertained by physiologists as to the production of
animal heat. I do not pretend to object to the correctness of the
doctrines taught, except in one particular. I fully agree with
Dr. Dalton in his concluding remark, that "animal heat, then, is
a phenomenon which results from the simultaneous activity of
many different processes taking place in many different organs,
and dependent undoubtedly on different chemical changes in
each one." The method of its production has not yet been sat-
isfactorily ascertained, scientific investigators themselves being
judges. The doctrine to which I object is that expressed by Dr.
Dalton in the following sentences : " The tissues require for their
nutrition a constant supply of solid and liquid food which is
introduced through the lungs. The disintegration and decompo-
sition of the tissues give rise, on the one hand, to urea, uric acid,
etc., which are discharged with the urine, and, on the other
hand, to carbonic acid which is exhaled from the lungs."

I have so often expressed my disagreement with physiologists
as to the doctrine they teach as to what becomes of the food after
it is absorbed, that I will not here again repeat my objections.

Animal Heat, 81

That the union of oxygen with coal and wood produces com-
bustion, no one denies ; but the proximate cause of the combus-
tion is ignition applied in some way. Animal heat is coexistent
with vitality. As a lucifer match causes coal or wood to burn,
s(5 vitality causes animal heat to be produced in the conversion of
food and drinks into blood; and in the conversion of this blood
into organized tissues when the tissues are formed. In animals,
as well as in trees and plants, vitality is ever operating, and is the
proximate cause of the union of oxygen with the food within
the living organism. But there is another product consequent
upon the union of oxygen with the food of plants and animals.
That product is motion. Animal heat is coexistent with, and
inseparable from, motion. The same is true in the life of plants
and trees. The temperature of the latter is but a few degrees
above the surrounding atmosphere, except when they are grow-
ing and flowering. During this period in plants heat is wonder-
fully developed.

" The rise of the thermometer when applied to the spadix of
the arum at the time of flowering has long been known. Sene-
bier found the temperature 7° higher than the surrounding
atmosphere. Hubert, in experiments on the arum cordifolium,
in the Isle of France, found the thermometer rise from Q&^, the
temperature of the surrounding atmosphere to 111°, when placed
in the center of the spadix, and in others to 121°, thus indicating
a difierence in one case of 45° and in others of 55°. The great-
est difference was observed to be in the morning. The accurate
experiments of Brongniart have rendered it more than probable
that in all cases of flowering heat is liberated, although from the
structure or size of the flower it may be impossible to detect it
by instruments." " It is well known that during the flowering
of plants oxygen is absorbed, and in some cases this absorption
has amounted to thirty times the volume of the subject of exper-
iment in twenty-four hours; during this time carbonic acid is
given off. These phenomena plainly indicate the cause of the
heat during the period of fertilization." All plants give off car-
bonic acid and absorb oxygen while flowering. The instances

6

82 Animal Heat.

referred to above show an excessive development of heat, conse-
quent upon an enormous consumption of oxygen. It may be said
to be the exaggeration of this law of vegetable life. Carbonic
acid, water, organic and inorganic substances in the soil consti-
tute the food of plants. The union of the oxygen of the atmo's-
phere with the organic part of this food develops growth ; the
flowering and seed-producing functions, heat and motion." (Bot-
any of the Southern States, by Prof. John Darby, A. M.)

Boussingault says, *^ Whatever be its. constitution and physical
properties, land will be fertile only as it contains organic matter
in a more or less advanced state of decomposition. There are
favored soils in which this matter is found in abundance, but
there are others in which it exists only in a very small quantity.
To become productive these lands require the intervention of
manure ; for this there is no substitute either in the labor which
breaks them up, nor in the climate which powerfully promotes
their fecundity, nor in the alkalies and salts which are such pow-
erful auxiliaries to vegetables.'' That is to say, plants must
always be supplied with organic elements of food, as well as with
an abundance of water, to enable them to grow vigorously, to
flower profusely, and bear seed abundantly. Plants give oif car-
bonic acid during the night and absorb oxygen. During the
day, while exposed to solar light and heat, they absorb carbonic
acid and give off oxygen ; though Soissure maintained that plants
give off carbonic acid at all times. Some plants, as mushrooms,
which are of very rapid growth, certainly do give off carbonic
acid while exposed to both the light and heat of the sun. All
plants give off carbonic acid more or less abundantly while flow-
ering. It is the active period of their organic life. Where, the
largest amount of heat is developed, and the greatest quantity of
oxygen taken up by them, no doubt an excessively rapid motion
in the sap or blood of the plant occurs. I do not know that any
experiments have been made to prove how excessively rapid this
flow of the sap may sometimes be ; but even during winter it con-
tinues. Dr. Carpenter says, " Some motion of the sap takes
place even in winter; and, as the earth at a few feet below the

Animal Heat ' 83

surface preserves a very uniform temperature, it is not improb-
able that the transmission of fluid derived from it through the
stem, may have an influence on the state of tTie latter. A sup-
position which is countenanced by the fact that the temperature
of the interior of a large trunk and that of the soil four feet
below the surface (which may be regarded as the medium depth
of roots) bear a very close correspondence.^' But a very im-
portant part of the food of plants is water. The soil may
be ever so rich in organic materials, yet without an abundant
supply of water they will not grow vigorously. Especially is this
the case when they are flowering and producing their seed. This
was well known to the Asiatics centuries ago. In the story of
the three calenders, sons of kings, and the five ladies of Bagdad,
when the third calender had been left alone in the enchanted cas-
tle, he visited the gardens and orchards which surrounded it, and
thus described what he saw^: "I ought not to forget, madam, to
acquaint you that this delicious orchard was watered after a very
particular manner; there were channels so artificially and pro-
portionably digged that they carried water in abundance to the
roots of such trees as wanted it, for making them produce their
leaves and flowers. Others carried it to those that had their
fruit budded; some carried it in lesser quantities to those that
had their fruit growing big ; and others carried only so much as
was just requisite to water those which had their fruit come to
perfection, and only wanted to be ripened. They exceeded the
ordinary fruits of our gardens very much in bigness; and lastly,
those channels which watered the trees whose fruit was ripe had
no more moisture than just what would preserve them from
withering."

It will not be contended by any one, I think, that effete mat-
ter is produced in plants or trees. Their food is converted into
sap, and this sap into the texture of the plant or tree. The
honey found in the flowers of many of them is a secretion, not
an excretion. Carbonic acid may be said to be the*excretion of
the plant, but it is an excretion produced in the conversion of
the sap or food of the plant into the texture of its organism. It

84 Animal Heat.

was not a part of that organism, nor was it separated from it as
effete matter. It is because physiologists suppose that the food
and drinks all go to form organized tissues, and that the excre-
tions thrown off from an animal body were a part of these
organized tissues, and that this law obtains at all times in ani-
mal bodies, that they have not been able to understand the
source of animal heat. We have said that wood and coal must
be ignited before they will burn. Not so in animal bodies.
Animal heat was an inherent part of the bioplasm existing
in the germs of life, whether those germs be animal or vegetable.
Animal heat was inherited by every living thing. We have
seen that vegetative life depends upon inorganic matter, organic
matter or manures found in the soil, upon a more or less abun-
dant supply of water, according to the conditions of growth, of
flowering, of fructification, and an abundant supply of solar
light and heat. The substances taken up by the roots of trees
or vegetables constitute their food. Mr. Darby has shown the
rapid and wonderful development of heat in flowering plants;
he shows also the enormous amount of oxygen absorbed by some
plants within twenty-four hours, during which time carbonic acid
is given off. The passage of the food into and through the tree
and flowering plant, and its conversion into leaves, blossoms, and
wood, must be rapid in proportion to the absorption of oxygen,
the throwing off of carbonic acid, and the development of heat.
Heat and motion always coexist. I believe it is admitted by all
physiological thinkers that when the cause of a thing is discov-
ered or ascertained which is sufficient to explain the facts or con-
sequences, we should therewith be content. All we have to do
is to satisfy ourselves that the explanation includes all the facts.
In plants as in animals we have vitality to begin with. It is
the proximate cause of all the organic movements in the body,
whether it be that of a tree or of a man. The temperature of
both plants and animals varies at different periods of the day.
This depeiiSs upon solar influence. In the higher order of ani-
mals it depends also upon a sort of periodicity of the circulation
of the blood.

Animal Heat. . 85

As to the part nitrogen performs in the growth of plants,
Berzelius says, " How the nitrogen in plants is obtained is still
more obscure than that of carbon. Plants and animals live en-
veloped by the air, which, in its ordinary state of moisture, con-
tains seventy-eight and a half per cent of nitrogen by volume.
Nothing is easier than to suppose that the nitrogen in living
bodies is derived from the air. But even if this supposition is
correct, 'there is in it a mystery which is not yet solved. Nitro-
gen, as we know, is found in the air in an allotropic modification
of a character similar to that found in silica, chromium, titan-
ium, etc., and in which it seems destitute of any disposition to
combine with any other bodies. If then their nitrogen is de-
rived from the air, there must be in nature some means by
which, under circumstances of which we have no certain knowl-
edge, it is changed from the indifferent allotropic modification
into the other state in which it enters into combination."

"Liebig supposes that the nitrogen in plants originates only
from ammonia, which is the only form in which nitrogen can be
assimilated by them, and that in this form it enters all nitrogen-
ous bodies. As he found a small quantity of ammonia in rain-
water, he supposes that the amount of ammoniacal gas in the
atmosphere is so great that rain-water every year transfers from
the air to the earth far more ammonia than is necessary, even
though there be taken from the soil rich harvests of grain, the
seeds of which contain a large per cent of nitrogen in propor-
tion to their weight. Mulder has, however, shown that Liebig's
hypothesis is wholly arbitrary in regard to the quantities of
ammonia which he himself finds in the air. Experiments by
Grazer show that rain-water which has been collected after long-
continued dry weather, and that after many days abundant rain,
contains about the same quantity of ammonia; but it is always
a mere trace, which is far less than Liebig assumes in his esti-
mates. Opposed to Liebig's theory are the experiments of Bous-
singault, according to which herbaceous plants did not arrive at
maturity from their seeds in earth which contained no nitrogen-
ous matter. The same results he found with the leguminous

86 Animal Heat.

plants, as peas, beans, and clover. Wheat and oats withered after
flowering without maturing their seeds, and the dry plants con-
tained exactly the quantity of nitrogen contained in the seeds
from which they were raised. In these cases the nitrogen is
wanting for the development of the seed, which accordingly
miscarry. Peas, beans, and clover grow with little luxuriance in
a soil devoid of nitrogenous matter ; but on planting more vigor-
ous seeds an analysis shows that the amount of nitrogen in the
ripe plants is double as great as in the seeds which produced
them. It seems from this to be evident that the first kind of
plants must receive their nitrogenous matter through the roots,
while the latter can assimilate the nitrogen diffused through the
atmosphere. Wungmann and Pollstroff planted cresses and the
lepidum sativum on finely-divided platinum wire, and supplied
them with water free from ammonia. The plants grew luxuri-
antly and produced well-developed seeds, the nitrogen of which
must have been obtained from the atmosphere."

Dr. Flint, vol. 3, page 424, 425, says, " From these facts and
other considerations that have already been discussed under dif-
ferent heads, it is evident that the physiological metamorphoses
of nitrogenized matter bear a certain share in the production of
animal heat, although in connection with inorganic matter their
chief function seems to be the repair of the tissues endowed with
the so-called vital properties." " What is the relation of the con-
sumption of non-nitrogen ized matter to the production of ani-
mal heat?"

" It has been pretty clearly shown that both sugar and fat are
actually produced in the organism, even when the diet is strictly
nitrogenized in its character; but we will only consider the non-
nitrogenized elements introduced into the body, assuming that
the principles of this class appearing de novo in the organism
are the result of transformation of non-nitrogenized substances."
"As far as the destination of the amylaceous, saccharine, and fatty
elements of the food are concerned, we only know that they are
incapable of themselves of repairing muscular tissue, and that
they can not sustain life. They are never discharged from the

Animal Heat 87

body in health in the form under which they enter; but are in
part or completely destroyed in nutrition. They are completely
destroyed in persons who, from habitual muscular exercise, have
very little adipose tissue. When their quantity in the food is
large, they are not of necessity entirely consumed, but may be
deposited in the form of adipose tissue. This, however, may be
made to disappear by violent exercise, or under an insufficient
diet." There can be no doubt that the non-nitrogenized class of
alimentary principles is craved by the system in long-continued
exposure to extreme cold. This is particularly marked with
regard to the fats. "In all cold climates fat is a most important
element of food ; and in excessively cold regions, while the nitro-
genized elements are largely increased, there is a very much larger
proportional increase in the quantity of fat. These facts are
very significant. If the non-nitrogenized elements of food —
which are not always indispensable, though often very necessary
articles — do not form tissue, are not discharged from the body,
and are consumed in some of the processes of nutrition, it would
seem that their change must involve the production of carbonic
acid, perhaps also of water, and the evolution of heat. It is so
difficult to ascertain the exact quantities of carbonic acid, watery
vapor, etc. thrown oflF by the lungs, skin, and other emunctories,
and to estimate the exact amount of heat produced and lost, that
it is not surprising that calculations of the calorific power of
diiferent articles of food should be frequently erroneous, particu-
larly as we have no means of knowing the exact calorific value
of the nitrogenized principles." " Though we may assume that
the non-nitrogenized elements of food are particularly important
in the production of animal heat, and that they are not concerned
in the repair of tissue, it must be remembered that the animal
temperature may be kept at the proper standard upon an exclu-
sively nitrogenized diet ; and we can not indeed connect calorifi-
<;ation exclusively with the consumption of any single class of
principles, nor with any single one of the acts of nutrition." In
those transformations within the living body wherein the action
of nitrogen is concerned, motion is produced, and heat is one of

88 Animal Heat.

the results as much so as in the union of the oxygen of
the atmosphere with the carboniferous portions of the food.
The effect produced by both is action, vital action, if you
please. This action originates the secretory and excretory
motion of the glands, one of the consequences of which is
animal heat.

In the extended extracts from the works of the distinguished
authors referred to, it will be observed that in the life of plants,
as well as in that of animals, when there is a large consumption
of food there is increased action with a corresponding develop-
ment of animal heat. These are the constant quantities. Phys-
iologists may differ as to the part played by oxygen or nitrogen
in the vital organism of plants or animals. I differ from them
in this : I maintain that heat is developed in the animal organism
during health through the various acts or functions, secretory
and excretory, by which the food is converted into blood.
Whatever may be the ultimate uses of food composed of sugar
and fats, one thing, in my opinion, is certain — they must first be
"converted into blood. The fact that they are both sometimes
found floating in the blood and in the lymph, only shows that
their conversion into blood is more difficult than that of food
composed of nitrogenous substances. This is applicable, perhaps,
more particularly to the fats. This difficulty requires increased
labor ; that is, greater action or motion.

The result of this increased motion is a larger evolution of
animal heat. By this wonderfully beneficent law men are enabled
to maintain a comfortable temperature while exposed to the most
intense cold. No doubt a vastly larger amount of heat is gener-
ated in their bodies than is produced in the bodies of men living
in the tropics, who live on fruits and vegetables ; but the amount
of heat does not arise above the standard of health, say 98°
F., because of the constant escape of heat from their bodies.
Physiologists have observed that the blood is* warmer in some
parts of the body than others. M. Claude Bernard proved by
experiment that the blood in the portal vein is warmer than that
in the aorta, and that the blood in the hepatic veins is several

Animal Heat 89

degrees warmer than that in the portal. It does not appear how
long after eating these experiments were made. If shortly after,
or within a few hours, there is increased action in the secretory
glands of the intestines, and also highly increased action in the
spleen which receives into itself and pours out into the portal
vein a large amount of blood. In both instances there would be
increased action 'or motion with a corresponding development
of heat. The same is true of the liver. There is a quadru-
ple or quintuple circulation in the liver — that of the hepatic
artery, portal veins, biliary ducts, hepatic veins, and lymphatic
vessels.

The liver no'doubt performs more labor than any gland within
the body, the lungs, perhaps, excepted. Hence the increased
motion with a corresponding increase in the temperature of the
blood. The blood found in the pulmonary veins, coming from
the lungs, would* no doubt be warmer than the blood of the
pulmonary artery entering these organs but for its exposure to the
atmosphere and the escape of watery vapor as has been observed
or remarked upon by different physiologists. The true explana-
tion, I think, why the temperature of the lungs and of the blood
found in the pulmonary veins is not as high as the temperature
of the liver and of the blood found in the hepatic veins, is this,
viz. when solids pass into a liquid form, and when liquids pass
into a watery or gaseous form, the heat evolved becomes latent.
It escapes from the lungs with the carbonic acid and watery
vapor expired as latent heat. By a wonderfully beneficent law
of the omniscient Creator this latent heat so removed from the
body is made to protect and preserve the life of animals and
of man in extremely cold climates; it is continually observed
in such climates that the beard of man and the hair around the
nostrils and mouths of other animals is covered with frost
when the men and animals are exposed to intense cold. The
watery vapor expired has frozen, and in the act of freezing the
latent heat contained in it is given out. The heat so released
lessens the intensity of the cold of the atmosphere surrounding
the mouth, nostrils, and face, which are less protected than the

90 Animal Heat

other parts of the body. There is a reason, then, why the lungs
should throw off heat in a latent form.

Herein is a law of organic life developing a physical or
chemical law, and the next link in this chain of causation, when
the expired vapor is frozen, is that the physical or chemical law
develops a vitalizing or life-preserving effect. Scientists, who
deny that design necessitates an intelligent Creator, will find it
difficult to explain how a dynamic force, acting upon inorganic
matter, comes to unite with a law of animal life in effecting so
beneficent a result, a result upon which the health and life of
thousands of men and animals (in the Arctic regions) depend.

But whenever secretory action is going on increased motion
attends it, with its constant companion, increased heat. This
applies to every gland in the body. Besides those referred to
above, it applies particularly to the skin, and also to the lym-
phatics, which are so widely distributed throughout the animal
economy.

When a man or horse exercises laboriously they become heated.
In this case the circulation of the blood is more rapid ; a greater
volume of blood is continually passing through the heart ; that
is to say, there is increased motion. But it may also be correctly
said the inspirations are deeper and fuller. A larger amount of
oxygen is consumed, and a larger amount of carbonic acid is
thrown off. Herein, no doubt, the theory of Liebig lies; an
increased quantity of oxygen unites with the carbonaceous por-
tions of the food floating in the blood or with the carbon in the
blood, the result being increased animal heat. But it must be
borne in mind that plants absorb oxygen and give off carbonic
acid during the night when their temperature is lowest, and give
off oxygen and absorb carbonic acid during the day when their
temperature is highest, except while flowering, when it is said
they absorb oxygen and give off carbonic acid in larger quanti-
ties under the influence of a midday sun. All that we positively
know is that the secretory and excretory organs are most actively
engaged when the largest amount of heat is evolved.

When we come to consider pathological conditions — take a

Animal Heat 91

fever case, for instance, where the patient eats nothing and the
system is feeding on itself; that is to say, effete matter affords the
material for all the excretions — we have greatly increased motion
in the circulation with a corresponding increase in the tempera-
ture of the body. On the other hand, examine a case with an
ague. Here we have greatly weakened action of the heart, a
smaller and smaller quantity of blood is passing through that
organ and through the lungs. It is congested within the cavi-
ties, particularly in the portal circle of the abdominal cavity.
Here we have a lowering of the temperature until the limbs
and parts of the body of the patient become icy cold. The most
obvious fact in this condition is the diminished and diminishing
motion or enfeebled circulation of the blood. This applies to
the cold stage of congestive fever and to the collapse of cholera.
The question of congestion and hyperemia, with diminished and
increased temperature of the body, will be fully considered in a
separate chapter. But it may be said that in the cold stage of
the maladies referred to the nervous system is involved.

As to the connection of the nervous system with the develop-
ment of animal heat. Dr. Flint says, " Helmboltz, DuBois Ray-
mond, and others have noted certain conditions which modify
the rate of nervous conduction. One of the most prominent
of these, first observed by Helmboltz, is due to modifications in
the temperature. By a reduction of temperature in the frog,
at least, the rate is very much reduced, and at 32° it is not
more than one tenth as rapid as at 60° or 70°. Marcy has
also noted that the rate is sensibly reduced by fatigue of the
muscle." "There is little to note under this head except the
fact that functional activity of the nerves produces an amount
of elevation of temperature in their substance which can be dis-
tinctly demonstrated by sufficiently delicate thermometric appa-
ratus.'' (Page 104, vol. 4.) "In 1854 Bernard repeated the
experiments of Pourfour DuPettit dividing the sympathetic in
the neck on the one side in a rabbit, and noted on the correspond-
ing side of the head and ear increased vascularity and an eleva-
tion in temperature amounting to from 7° to 11° F." (Page 437.)

92 Animal Heat

"It has been shown by direct experiments upon living ani-
mals that local variations in the circulation, independent of the
action of the heart, actually take place, and that they are of great
importance in special functions ; and there are numerous instances
of such action which can only take place through the nervous
system. The phenomena of blushing and pallor from mental
emotion are familiar examples.'^ (Flint's Physiology, vol. 4.)

"That local variations in the circulation, independent of the
action of the heart," may occur, and do occur, when a nerve is
divided, as in the experiment performed by Bernard, there is, we
suppose, no doubt; but that blushing and sudden pallor occur
independent of the heart's action we deny, the individual being
in a state of good health. Numerous experiments have been
made to ascertain precisely the rapidity of the circulation. It
is wonderfully quick, sufficiently so for both pallor and blushing
to be produced by an altered condition iii the heart's action. The
ancients supposed the heart to be the seat or organ of the emo-
tions and affections. To-day, in everyday life, men constantly
speak of the heart in the same sense. It is because men have
observed that the heart's action is constantly affected by every
emotion, whether that emotion be produced by seeing or hearing,
or even by our own reflections without seeing or hearing any
thing. Both physiologists and pathologists are too much dis-
posed to overlook the heart's action and to seek for an expla-
nation in the action of the capillaries, simply, we think, because
these are more particularly the subject of microscopic examina-
tions. Were the ear applied over the heart or the finger to the
radial artery at the time that a maiden blushes we do not doubt
it would be discovered that there was increased force in the
heart's action, and also in the case of sudden pallor that there
would be diminished force; the one of these states is accom-
panied by increased, the other by decreased motion with corre-
sponding higher and lower temperature.

Without stopping here to notice particularly M. Bernard's
experiment, we will only call the attention of the reader to the
fact that the increased temperature observed is dependent on

Animal Heat. 93

increased motion in the circulation of the blood through the
capillaries in the part which was supplied by the divided nerve.
Here we find that although the increased capillary circulation
may be independent of the heart's action, the increased temper-
ature is not independent of increased motion. In both physi-
ological and pathological conditions the temperature of the body
of the living animal is so dependent upon increased or dimin-
ished motion in the circulation of the blood and of the nervous
fluid, that it is inseparable from it.

In pathological conditions heat is generated in some part of
the body so long as destructive metamorphosis is going on in the
living animal. The greater the motion the greater the amount
of heat produced. The American Indians kindle a fire by rub-
bing two hard and dry sticks together. The sticks would have
remained an indefinite time surrounded by the oxygen of the
atmosphere. It was friction or motion which ignited them.

94 The lAver,

CHAPTEE VII.

The Liver.

" The liver is situated just below the diaphragm in the right
hypocondriac region, and is the largest gland in the body, weigh-
ing, when moderately filled with blood, about four and a half
pounds. Its weight is somewhat variable, but it is stated by
Sappey that in a person of ordinary adipose development its pro-
portion to the weight of the body is about one to thirty. In
early life the liver is relatively larger, its proportion to the weight
of the body in the new-born child being as one to eighteen or
twenty.''

" The liver is covered externally by the peritoneum, folds or
duplicatures of this membrane being formed as it passes from the
surface of the liver to the adjacent parts. These constitute four
of the so-called ligaments that hold the liver in its place."

" The proper coat of the liver is a very thin, but dense and
resisting, fibrous membrane adherent to the substance of the
organ, but detached without much difficulty, and very closely
united to the peritoneum. This membrane is of variable thick-
ness at different parts of the liver, being especially thin in the
groove for the vena cava. At the transverse fissure it surrounds
the duct, blood-vessels, and nerves, and penetrates the substance
of the organ in the form of a vagina or sheath surrounding the
vessels and branching with them. This membrane, as it ramifies
in the substance of the liver, is called the capsule of Glisson.''
"At the transverse fissure, the portal vein, collecting the blood
from the abdominal organs, and the hepatic artery, a branch of
the celiac axis, penetrate the substance of the liver, with the

The Liver, 95

hepatic duct, nerves, and lymphatics all enveloped in the fibrous
vagina or sheath known as the capsule of Glisson."

" The portal vein is by far the larger of the two blood-vessels,
and its caliber may be roughly estimated at from eight to ten
times that of the artery."

"The blood which has circulated through the capillaries of
the stomach, spleen, pancreas, and intestines, is collected by the
roots of the corresponding veins and discharged into the portal
vein, which enters the liver at the transverse fissure of the organ."
" Immediately upon its entrance the portal vein divides into
two branches, right and left, which supply the corresponding
portions of the liver, and these branches successively subdivide
into smaller twigs and ramifications until they are reduced to the
size, according to Kolliker of ^^-qq of an inch in diameter."

"The portions of hepatic substance included in this way
between the terminal branches of the portal vein are termed the
' acini ' or * lobules ' of the liver, and the terminal venous branches
occupying the spaces between the adjacent lobules are ^interlob-
ular veins.' "

"In the spaces between the lobules we also find the minute
branches of the hepatic artery, and the commencing rootlets of
the hepatic ducts."

"The hepatic duct is formed by the union of two ducts, one
from the right, and the other from the left lobe of the liver. It
is about an inch and a half in length, and joins at an acute angle
with the cystic duct to form the ductus communis choledochus.
The common duct is about three inches in length, of the diame-
ter of a goose-quill, and opens into the descending portion of the
duodenum. It passes obliquely through the coats of the intes-
tine, and opens into its cavity in connection with the principal
pancreatic duct. The cystic duct is about an inch in length, and
is the smallest of the three canals."

"The gall-bladder is an ovoid or pear-shaped sac about four
inches in length, one inch in breadth at its widest portion, and
capable of holding from an ounce to an ounce and a half of
fluid."

96 The Liver,

The above extracts are taken from Flint and Dalton. The
hepatic duct is made up of the biliary ducts which come from all
parts of the liver. In this respect they resemble the lymphatic
system, which, commencing in all parts of the body, finally ter-
minates in the thoracic duct and right lymphatic duct. Of the
nerves going to the liv^r and the lymphatics of that organ it is
unnecessary in this connection for us to speak. We purposely
avoid attempting to notice the microscopic anatomy of the liver,
or even to allude to the learned researches made in reference to
its microscopic anatomy. There are six systems of circulation
in the liver: the hepatic artery and portal vein, which carry
blood to the liver; the capillary system of blood-vessels in it;
the hepatic veins, which carry the blood from the liver; the
biliary ducts, which together form the ductus hepaticus, and
empty the bile into the duodenum ; and the lymphatics, which
empty their contents into the thoracic duct. Besides these arte-
ries, veins, capillaries, lymphatics, and biliary ducts there are the
nerves going to the liver which modify or control the action of
them all. The hepatic artery performs the same office for the
liver that the coronary arteries perform for the heart, as also the
bronchial arteries do for the lungs, and enable it to perform its
varied and laborious functions. The blood carried to the liver by
the hepatic artery may be subjected to some alteration in its pas-
sage through that organ, as all arterial blood is changed in its pas-
sage through the capillary system into the venous system in every
part of the body. But arterial blood is not carried to the liver
specially to be changed, as is the great volume of blood carried
to that organ through the portal vein. The lymphatics of the
liver are not unlike the lymphatics of other parts of the body.
The same may be said of its capillary blood-vessels and of its
nerves. The remarkable peculiarity in the circulatory system of
the liver is this, the arterial blood conveyed from the heart to
the abdominal organs is not returned directly to the heart by the
veins, as is the case in all other parts of the body, but it is
taken up by a system of veins which do not go to the heart at
all. These are the portal veins. These veins originate in the

The Liver, 97

stomach, in the intestines, small and large, from the pyloric orifice
of the stomach to the anus ; from their mucous as well as from
their serous membrane or peritoneal coat; from the mesentery
and mesenteric glands; from the pancreas, and from the spleen,
all of which empty into the portal vein. When an individual is
in a state of perfect health these veins may be said to carry blood
comparatively pure into the great portal vein. This blood,
however, is deprived of many of the constituents it contained
when it left the heart. That which goes to the stomach sup-
plies that organ with healthy mucus and also its gastric juice.
That which goes to the intestines supplies the mucus which lines
their inner coats, and also the intestinal juices secreted by the
innumerable glands formed within the intestinal tube. That
which goes to the mesenteric glands supplies the secretions
which are mixed up with the chyle as it passes through them
on its way to the thoracic duct. That which goes to the pan-
creas supplies the pancreatic juice. The blood which left the
heart, I say, supplies all of these secretions before it enters the
veins which convey it to the liver. In the varied functions which
this blood is thus made to perform, it is deprived of many of its
constituents and is meager in vital power.

This is its condition in health. What must be its condition
when subjected to all the morbid or pathological conditions
which may exist, and which constantly do exist, in the alimentary
canal from the termination of the esophagus to the anus? What
must be its condition on returning from disordered or diseased
mesenteric glands, or from pancreas functionally or organically
disordered. It would be difficult to name the malady to which
flesh is heir that does not affect injuriously some portion of the
alimentary canal with its appendages. It may be a malady
gradual in its approach and slow in its progress, as dyspepsia ;
or it may be a sudden seizure, which pours out gallons of rice-
water, so-called, as cholera. It may be dysentery, with its muco-
purulent and bloody discharges; or it may be typhoid fever with
its ulcerated glands, and patches of glands, in the small intes-
tines ; or it may be peritoneal inflammation, with its sudden and

7

98 The Liver.

destructive tendencies ; or it may be the piles, which hold for a
long time in its enlarged and pouchy veins disordered blood.
All these, and other maladies I might name, affect the blood
which has to be returned to the liver through the portal vein.
Such is the condition of the blood upon which the liver has to
act when the individual is sick. And yet, remarkable to state,
there are physiologists who maintain that the liver does not sepa-
rate effete matter from the blood. Dr. Flint says, "Inasmuch
as cholesterin is the only excrementitious principle as yet dis-
covered in the bile, bearing the same relation to this fluid that
urea does to the urine, it is evident that the ideas of the physiol-
ogist with regard to any excretory function of the liver must
have been very indefinite before the relations of cholesterin had
been determined." We will refer to this again, and also to the
absurd notion that the kidneys in health separate effete matter
from the blood. It must always be borne in mind, and I can
not too frequently repeat it, that physiologists define effete matter
to be something which has been a part of living organized tissue,
as flesh, nerves, brain, and bone.

But to return, it is no less astonishing to me that after all the
patient, laborious, and learned researches, made by so large a
number of eminent physiologists distinguished for their knowl-
edge in many departments, there has not been one among them
to discover the offices and uses of the spleen. I have stated, just
above, the alterations to which the blood is subjected, even in
healthy individuals, in its journey from the heart to the liver
through the abdominal organs. I have also briefly stated how it
must be mixed up with corrupt and vitiated secretions, when the
abdominal organs through which it has to pass are functionally or
organically disordered or diseased. It is to correct this altered
or diseased condition of the blood that the spleen stands ready to
pour continually into the portal vein fresh arterial blood reviv-
ified, if I may so express it, by its passage through that ductless
gland. I know that the spleen has been removed from dogs and
yet they lived ; but I also know that there never was a man with
a large or diseased spleen in his body who enjoyed good health.

The Liver, 99

In a former chapter, while I was following the food after it
had entered the blood-vessel system, I pursued it up to the spleen,
where the connection of my subject compelled me to leave it. I
must now return to it. As to the alterations in the blood in the
passage through the spleen, the only positive conclusions, to
which physiologists have come, can be expressed in a single
sentence : '^ Beclard and Gray observed a marked increase in the
fibrin and albumen in the blood of the splenic veins." All phys-
iologists admit, indeed they all teach, that fibrin and albumen are
two of the most important constituents of the blood. They are
two of the elements out of which the red corpuscles are formed.
Could there be two any more important elements poured into the
altered or vitiated blood coming from the abdominal organs ? It
seems, to my common-sense view, an all-sufficient function for the
spleen to be continually pouring into the portal vein these highly
organized elements of vitality.

Let it be borne in mind, as stated in a former chapter,
that the increased quantity of albumen and fibrin found in the
splenic veins is formed from the food floating in the blood as it
passes through this elaborately organized ductless gland. The
liver has three important functions to perform. The first is
to assist in converting the food into blood; the second is to
remove effete matter from the blood ; and the third to convert
effete matter, and that portion of the food which ought to be
separated from it, into bile. The first of these functions of the
liver, physiologists ignore altogether. They all seem to suppose
that so soon as the food is taken up from the stomach and intes-
tines by the venous absorbents, and by the lacteals, it becomes
blood. After this absorption they treat of it and speak of it
only as blood. So far has this notion taken possession of the
minds of the physiologists that when M. Claude Bernard dis-
covered sugar in the hepatic veins, he proclaimed to the world
of physiologists that he had discovered that the liver possessed
a glycogenic or sugar-producing function. Some of the ablest
physiologists in the world are now engaged in microscopic and
chemical analyses and examinations to prove or to disprove the

100 The Liver.

truth of this discovery. When it is considered that more
than one half of the food of more than one half of the hu-
man race is converted into glucose, one of the forms of sugar,
before it enters the portal veins, is it not passing strange that
physiologists would not expect to find sugar in the liver? One
of the functions of that organ is to convert this glucose into
blood, and in the process of this conversion what it separates
from the glucose it forms into bile. M. Bernard divided the
eighth pair of nerves in the neck of a rabbit and found, he says,
that the glycogenic function, or ability, of the liver was greatly
lessened. This he imagines to be ^' confirmation strong as proof
of holy writ ^^ of the truth of his theory. Did it not occur to
him that the pneumogastric nerves are distributed to the stomach
and duodenum, and, perhaps, to the small intestines, as well as
to the liver? If the pneunaogastric nerves control the functions
of the liver, they control also fully as much the digestive func-
tions of the stomach and intestines. Digestion, then, would be
greatly interrupted in its first processes, and less glucose would
be formed from the food, than if the animal were in a state of
natural health. Of course, in this case, less glucose would enter
the liver through the portal vein. The sugar found in the hepatic
veins by M. Bernard was that which has passed through the liver
unchanged, as fatty emulsion is sometimes found in the arterial
blood immediately after it has passed through the lungs. Ordi-
narily fatty emulsion, after it leaves the thoracic duct, and enters
the circulation through the descending cava — ordinarily, I say —
is so changed in its passage from the right to the left side of the
heart through the lungs that it can no longer be detected in the
blood of the aorta or carotid artery. The same is also, no doubt,
the case with the glucose which enters the liver through the
portal vein. Sometimes, perhaps, it is all changed, so that no
sugar, as such, can be found in the hepatic veins; but when the
amount of glucose is large or excessive the liver is not capable
of changing it all in its first passage. It is then detected in the
hepatic veins.

The livers of lambs, pigs, and beeves, when prepared for the

The Liver, 101

table, are always sweet. It is because these animals are fattened
on food which contains a very large amount of glucose or sugar ;
not because of any glycogenic function of their livers. The
liver is rather a sugar-destroying than a sugar-producing organ.
As said above, it separates certain of the coarser elements from
the glucose food and forms them into bile, and thus prepares the
other part for the more ready transformation into blood. The
current of blood through the liver is not like the flow of waters
down a river. The same water perhaps never descends the Ohio
or Mississippi rivers the second time; certainly not until after it
has been evaporated from the ocean and raised to the clouds. As
to food, it commences to pass from the stomach and intestines to
the liver soon after it is eaten ; but when some hours elapse, as
proved by the experiments of Dr. Beaumont and others, before
all the food has entered the portal veins, then that portion which
first passed through the liver has repassed again many times
before what is commonly called digestion is completed. The
food thus. floating in the blood is again and again subjected to the
separating and secreting powers of the liver. Physiologists have
proved by experiment, certainly to the satisfaction of the most
of them, that an increased flow of bile into the duodenum com-
mences with the beginning of digestion, and continues during
the whole time of that process. The only reason they give to
account for this increased flow of bile is because of the part they
suppose it has performed in the transformation of chyle and
chyme into albuminose and glucose and fatty emulsion. Strange,
astonishingly strange, that they never considered the fact that
this bile is secreted from portal blood, at a time when a very
large proportion of this blood is made up of fresh glucose and
albuminose continually flowing into it.

Glands and ihQ capillary blood-vessels are the only transform-
ing organs in the animal economy. Very certain is it that the
food, after being absorbed, is subject to no transforming process
before it enters the liver. The constitution of the food is then
subjected to its second metamorphosis. It underwent its first
change in the stomach and intestines. But the liver has to act

102 The Liver,

upon the nitrogenized forms of food as well as upon that con-
taining carbon. When the diet is mixed both forms pass through
that organ at the same time. What is separated from both is
converted into bile. The probability is, for nothing can be
determined about it positively, that this variety of bile passes on
directly through the hepatic duct and the ductus communis into
the duodenum. I suppose so, because of its continued flow into
the duodenum while digestion goes on. There is no reason why
any part of it should at that time be turned aside into the gall-
bladder. Some animals, as the horse, have no gall-bladder.
Where they do exist, we must suppose it is to retain the bile in
them during a longer or shorter time for some purpose. The
food in the blood having undergone its second metamorphosis in
the liver, passes on through the hepatic veins into the vena cava,
which conveys it to the right side of the heart. From thence it
passes to the lungs, where it undergoes its third metamorphosis,
being there mixed with the oxygen of the atmosphere. Imme-
diately after this it enters the left side of the heart, w'hich dis-
tributes it to all the parts of the body in the general current
of arterial circulation. The lymphatics, commencing in all parts
of the body where capillary vessels are found, stand ready to
separate from the blood a part of this fresh material, which they
convey to the thoracic duct. It passes through their glands, and
is more highly elaborated, producing, presently, white corpuscles.
But a large portion of this food is carried along by the blood to
the skin, which, by its perspiratory glands, separates from it a
large proportion of its watery contents.

In a former chapter we have stated particularly how large a
quantity of fluid is mixed up with the food. We refer to the
saliva, the gastric and intestinal juices, the pancreatic juice, the
bile, and the lymph. The skin separates a very small fraction
of the solid parts of the . food, being less, we believe, than five
parts in a thousand. But the food is also carried continually
along with the current of arterial blood tg the kidneys. These
separate from it a very large part of its watery elements, and
along with this water, urea, creatin, etc., and inorganic sub-

The Liver, 103

stances. The liver separates from the food substances which it
changes into bile. The lungs are continually throwing off car-
bonic acid and watery vapor. What proportion of the food,
solid and liquid, escapes from the lungs in the shape of carbonic
acid, or watery vapor, as it — the food — passes through the lungs,
I am not prepared to state. The kidneys separate from it a very
large quantity of both fluid and solid materials. Physiologists
seem to be agreed that there is no catalytic ciiange effected in
the kidneys; in other words, that these wonderfully elaborated
organs do not create or form urea, creatin, etc. from the blood
as it passes through them. They seem to come to this conclu-
sion because urea is found in the blood, as also in the lymph.
I suppose that urea is formed from the food as it passes along
with the blood through the kidneys, and that this is one of the
great processes by which the food is converted into blood. All
the materials of the urine, liquid and solid, must have existed at
one time in the food and drinks. The urea thus formed in the
kidneys does not all sometimes pass off through the ureters into
the bladder. A part of it is conveyed by the renal veins into
the vena cava. It is thus found sometimes in the blood, and
when there i^ over a certain proportion of it it gives rise to a
very serious form of disease. No one denies that the liver
secretes bile, but all know that the quantity poured into the
duodenum is variable. It no doubt sometimes happens that the
urinary ducts fail to convey into the ureters all the urea which
had been created. The ureters may sometimes fail in the per-
formance of their duties as conduits to the bladder. When the
urea enters the blood through the renal veins, it seems to be one
of the functions of the lymphatics to separate it from the blood.
Hence urea is sometimes found in the lymph. Why should it
be thought strange that the organic and inorganic parts of the
urine are separated from the food? Organic life, whether in
plants or in animals, consists in the conversion of food and
drinks into sap and blood, and the conversion of these latter
into organized living tissues or forms. It is in the first part
of these wonderful processes of nature that I suppose the separa-

104 The Liver.

tions to take place. In other words, that the excrementitious
matter thrown off from a living body is separated from the food
in the process of changing it into blood. Physiologists, perhaps
without exception, teach that the food is first formed into living
organized tissues; that there is a constructive and destructive
metamorphosis continually going on; and that all excretions,
properly so-called, except, perhaps, a part of the feces, were
once a part of the living body. In this scientific muddle they
find it necessary to weigh exactly the quantity of food and drinks
swallowed to calculate precisely in how short a time a man's
entire body is made out of new material. Dr. Dalton makes
the time exactly twenty days. There are cases of typhoid fever
in which a man's body is re-created two or three times before his
physician pronounces him convalescent. This, of course, is when,
that wonderfully wise and scientific practice is pursued, as is the
rule, according to Dr. Thomas King Chambers, in the London
hospitals, where the patients are compelled, willing or unwilling,
appetite or no appetite, to swallow every two hours, night and
day, a certain quantity of milk and beef tea, amounting in
twenty-four hours to a half gallon or more, besides, in many
cases, solid food. Such philosophizing has caused physiologists
to be unable to understand the functions of the liver. The fol-
lowing extract shows, as fully as it can well be done in so many
lines, the absurdities taught by physiologists as to the functions
of the liver and kidneys :

"There are two probable sources of urea in the economy,
assuming that it always preexists in the blood, and is not formed
in the kidneys. One of these is the disassimilation of the
nitrogenized constituents of the tissues, and the other in a trans-
formation in the blood of an excess of the nitrogenized elements
of food. Urea, as we have already seen, exists in considerable
quantity in the lymph and chyle, and is found also in small pro-
portion in the blood. It has lately been detected in still smaller
quantity in the muscular tissue ; but chemists have thus far been
unable to extract it from any other of the solid tissues, under
normal conditions, except the substance of the liver. The fact

The Liver, 105

that it exists in considerable quantities in the liver has led to the
supposition that this is the organ chiefly concerned in its produc-
tion. With the small amount of positive information that we
have upon this point, the view that the liver produces urea, while
the kidneys are the organs chiefly concerned in its elimination,
must be regarded as purely hypothetical. But if it be true that
urea is the result of the physiological wear of the nitrogenized
elements of the body, the liver would probably produce its share
in the ordinary process of disassimilation. The fact that urea
has not been detected in normal muscular tissue is by no means
a conclusive argument against its formation in this situation.
We have lately shown that, although the liver is constantly
producing sugar, none can be detected in *its substance, for the
reason that it is washed out as fast as it is formed, by the current
of blood. In the case of the muscles, it is by no means improb-
able that the lymph, and perhaps the blood, washes out the urea
constantly, and keeps these parts free from its presence during
normal conditions. In some late experiments by Meissner, in
which the observations of Prevost and Dumas on the accumula-
tion of urea in the blood of nephrotomized animals w^ere con-
firmed, urea was found in dogs and rabbits, after removal of the
kidneys, not only in the liver, but in the muscles and brain.
Although our experimental knowledge does not warrant the
unreserved conclusion that urea is produced primarily in the
nitrogenized parts of the organism, particularly the muscular
tissue, this view is exceedingly probable, and we must wait for
further information on this subject, until physiological chemists
are able to follow out more closely, the exact atomic changes that
intervene between the functional operation of organized parts
and the change of their substance into excrementitious matter.'*
(Flint's Physiology, vol. 3.)

There is no department of science but medical in which an
investigator, who has found out to his entire satisfaction that a
particular organ performed one especial function, would jump
to the conclusion or conclusions that this organ also performed
other and entirely diflerent functions. No physiologist denies

106 The Liver,

that the special function of the liver is to produce bile. This
physiological fact was known to the earliest medical observers.
It was for modern philosophers to discover that one of the func-
tions of the liver was to produce, or create, sugar, and that
another probable function was to produce, or create, urea. It is
not said whether the urea, sometimes discovered in the liver, is
found in the lymph or blood of that organ. But this is not all.
Physiologists have discovered urea in the muscles, and where the
kidneys have been removed, also in the brain ; hence they have
jumped to the conclusion that both the muscles and the brain-
substance may generate urea.

In the animal economy the separation, call it secretion or
excretion, of whatever is to be used in the body, or is to be
thrown out of the body, is performed by organs called glands.
This applies to the saliva, the gastric and pancreatic juices on
the one hand, and to the milk, urine, and sweat on the other
hand. Bile is sometimes found in the blood, and the whole
surface of the body sometimes becomes as yellow as a pumpkin.
As well might you say that it was produced in the blood, or
created in some inexplicable manner by the skin, as to suppose
that urea is formed in the liver, muscles, or the brain, because it
is sometimes found in, near, or about those organs or substances.
It is only because it is sometimes found in those situations, that
microscopic observers have come to the conclusion that it is not
formed by the kidneys. Leaving the solid substance in which
they say urea is found — liver, muscle, brain — they say also that
it is found in larger quantities in the lymph and chyle than in
the blood. Here we have six sources for the formation of urea.

Could any other than medical philosophers suppose that Nature
thus departs from her universal, invariable law? There is not
an instance in the wide domain of Nature in which one definite
entity with fixed proportions is produced by, or is the result of,
more than one agency or cause. As to the milk, tears, saliva,
gastric juice, intestinal juices, pancreatic juice, spermatic fluid,
no physiologist even is simple enough to believe or to state that
they are formed all over the body. But why do physiologists

The Liver. 107

deny that the kidneys separate and make from the food urea,
creatin, creatinin, and all the salts, etc., found in the urine? It
is because they stand upon the baseless hypothesis of constructive
and destructive metamorphosis, which they suppose to be contin-
ually going on in the animal body. Dr. Flint says, "There are
two probable sources of urea in the economy, assuming that it
always preexists in the blood and is not formed in the kidneys.
One of these is the disassimilation of nitrogenized constituents
of the tissues, and the other is the transformation in the blood
of an excess of the nitrogenized elements of food.^^

If urea is produced by the processes here first stated, the cata-
lytic change must occur in the capillaries, for they are the organs
by which all growth and increase are effected on the one hand,
and all decrease or waste are effected on the other; in other
words, they are the organs of constructive and destructive assim-
ilation and disassimilation. The capillaries empty their contents
into the veins. We know that they empty into them a different
kind of blood from that which they received from the arteries —
blood containing less oxygen and more carbonic acid.

If urea, then, was formed by the disassimilation of nitrogen-
ized living tissues, venous blood ought to be constantly full of it,
which is not the fact.

If, however, as I suppose, urea is formed from the food by the
kidneys, and if also, as I suppose, all the urea so formed does
not constantly pass into the ureters, a part of it escaping through
the renal veins into the vena cava, then we can understand how
the lymphatics which follow the arteries should take it up from
the blood floating in them, thus causing the lymph to contain a
greater quantity of urea than the blood, and how it may be
found in muscle, brain, or liver-substance.

As to Dr. Flint's second hypothesis, that urea may be formed
in the blood itself, it is too absurd to notice.

The fact that urea is found to an excess in animals from which
the kidneys had been removed, proves no more as to the func-
tions of the kidneys than do the few instances recorded by anat-
omists where the ductus communis choledochus does not empty

108 The Liver.

into the duodenum prove as to the functions of the liver. We
know that there are such things as vicarious functions under
anomalous conditions. Physiological laws are not to be learned
from monstrosities or singular mutilations. We only learn from
such the wonderful adaptability of Nature's laws to unusual con-
ditions. To-day, so far as medicine is to be studied as a healing
art, there is no gland in the body considered to be so altogether
unimportant as to its functions as the human liver. According
to the highest medical authorities in Philadelphia, New York,
London, and Paris, less attention is paid to the action of the liver
in the treatment of diseases than to any other organ in the body.
Assimilation and disassimilation, as taught in the books, are
constantly before the mind's eye of the medical practitioners.
The effete matter so produced is to be removed, according to the
same teaching, by the skin and kidneys, especially by the latter
organs.

Effete matter is to be considered under two entirely different
conditions; the one is effete blood, the other is effete matter
which has been a part of the living organism. From the begin-
ning of life in the fetus in utero to the period when growth
ceases, provided there has been no sickness and the individual
has continued to increase in weight, or not at any time to lose in
weight, there is only effete blood. During this period, let it be
longer or shorter, all the excretions proper, all that which is
thrown off from the body, is the result of the conversion of the
food into blood. This does not apply, of course, to the trimming
of the nails and cutting of the hair, nor to the shedding — so to
call it — of the cuticle or scarf skin, or the removal of the epithe-
lial covering of the mucous passages; nor does it apply to the
teeth. Neither of these are excretions in the common accepta-
tion of the word. Crawfish, crabs, and lobsters shed their shells
or outer coverings every year. Deer and elk shed their horns
every year. If the law of constructive and destructive meta-
morphosis were true, as taught by physiologists, neither the Crus-
tacea would shed their shells nor would deer and elk shed their
horns. According to this law both the shells and horns would

The Liver, 109

have been renewed eighteen times in a year with five days to
spare, allowing twenty days for the complete metamorphosis,
according to Dr. Dalton. The shells of crabs and lobsters and
the horns of deer and elk are as hard as bone.

It is a singular fact about deer, that if they are castrated after
their horns are fully grown, that is, after having passed out of
the velvet state and become hard, they never shed them again.
I have been told that when they are castrated without horns the
latter never grow out again. The same law may apply to elk. It
is impossible for physiologists to explain these facts and still
maintain the doctrine they teach. But it is not a matter of little
or no consequence whether they or I teach the truth. The laws
of hygiene, the diet of the sick, and the treatment of diseases,
are all made to depend upon what is or what is not effete matter.

In 1838 Mr. W. Grisenthwaite published in London an Essay
on Food. He denies this doctrine of metamorphosis or total
change of the body in so many weeks, months, or years. He
goes into very nice and particular calculations to show that in a
healthy man, not increasing in weight, the amount of the excre-
tions correspond exactly with the amount of food and drink
swallowed. I do not pretend to say whether his calculations
are correct or not. I know that there are many erroneous
positions taken in his book. Besides the general fact, I agree
with very little that he says. He promised to explain several
questions more fully, but this little essay is the only one of his
works I ever saw or heard of.

To return, I maintain that the first form of effete matter is
effete blood, blood which has served its purposes but was never
a part of living organized forms. This effete blood was elimi-
nated from the body by the lungs and liver, in the one case it
b^ing thrown off as carbonic acid, in the other as bile. This
is the only elimination in a healthy body after the food has
been formed into blood by the various and wonderful processes
through which I have followed it in these pages.

' It is not within the scope of this chapter to speak of the car-
bonic acid thrown off by the lungs in a state of health; I will

110 The Liver,

only state the fact that the lungs throw oif much larger quanti-
ties of this effete blood in the form of carbonic acid than does
the liver in the form of bile. The quantity of carbonic acid
thrown off by the lungs in a healthy man weighing one hundred
and forty pounds has been estimated as high as eleven ounces in
twenty - four hours. The throwing off of carbonic acid by the
lungs is not more important in the maintenance of health than
is the separation of bile by the liver. Indeed, it can hardly be
considered as much so, for the carbonic acid goes immediately
out of the body, whereas the effete blood separated by the liver
is converted into bile, which has important functions to perform.
During fetal life the liver is the only gland by which effete blood
can be removed from the living system. Until the child breathes
no carbonic acid can be thrown off, nor urine from the bladder.
If the metamorphosis doctrine of physiologists were true, and if,
also, the kidneys separated effete matter from the blood, then the
bladder ought to be enormously distended ; indeed it ought to be
many times larger than the body of the new-born infant; for,
dividing two hundred and seventy days, the period of fetal life,
by twenty days, the time of entire renewal, according to Dr. Dal-
ton, the bladder would contain the debris of thirteen and a half
fetal existences. Such are the absurdities to which this doctrine
leads us. Physiologists deny that the meconium found in the
intestines of new-born infants comes from the liver, because bile
can not be detected in it, according to Pettinkofer's test, although
they admit that traces of bile are found in the small intestines
as early as the fifth or sixth month of fetal life. The constituent
elements of saliva, of the gastric and pancreatic juices, and of
mucus, are well known. I do not suppose that any physiologist
will maintain that either saliva, gastric, or pancreatic juices are
poured out into the duodenum daring fetal life. The only sources,
therefore, from which substances found in the intestines at birth
can come, are the bile and mucus. It is a mixture of both.

According to Dr. Flint, one of the methods by which urea
may be formed is that it is generated in the blood-vessels. It
is a ridiculous absurdity, but he and those who agree with him

The Liver. Ill .

must admit that it would not be as singula catalytic change to
form meconium out of bile and mucus and epithelial cells, if
you choose, as it is to form urea de novo out of pure blood. If
you can not detect bile in meconium, you can not detect blood in
urea. The quantity of meconium found in the bowels of new-
born infants varies considerably. It no doubt depends greatly
upon the healthy or sickly life of the fetus. The size of the liver
is, during that period and for some time after birth, much larger
in proportion to the height of the body than at any other time
during life. Effete blood is the only substance to be removed
from the circulatory system of uterine fetal life, and it is the
especial duty of the liver to remove it. No other secretory ex-
cretion then takes place. According to my observation during
a practice of forty-three years, and according to that of many
physicians far more distinguished than I am, running back for
generations, there is not in the whole materia medica a single
medicine which acts so kindly and curat! vely as calomel in the
treatment of the affections of infants and young children. The
distinguished Dr. Benjamin W. Dudley used to say to his class
that an old Scotch doctor was wont to say that with the blessing
of God and a phial of calomel he could cure all the children in
the kingdom, and Dr. Dudley concurred with the Scotch phy-
sician.

The second form of effete matter comes from the waste of the
solid parts of the body — call it destructive metamorphosis or
disassimilation, as you please. It is never separated from the
solid parts except with a corresponding loss of weight of the
whole body. It may be so separated during good health by exer-
cise or labor, as particularly in the training of a race-horse or
an athlete; but in the human race it far more frequently occurs
when the organic life of the individual is interfered with by some
sort of sickness. As to this form of effete matter, we do not
have to go dodging and hunting around with a rush-light and
microscope to see wl^ether it is produced in the liver, in the
muscles, or in the brain, or whether it is found in the lymph, in
the chyle, or in the blood. We know that it is separated from

112 The Liver.

the living organism in every part of the body by the capillary
blood-vessels. I say that we know that such is its origin,
because no physiologist disputes the fact that capillary vessels,
call them by what name you please, do separate milk, saliva,
gastric juice, pancreatic juice, bile, etc., each of which is made
up of both solid and liquid constituents. That this separation
of effete matter, takes place in some part of the organism to a
far greater extent than in other parts, there can be no doubt.

Perhaps there is less effete matter taken from the substance of
the nerves, the bones, and the brain, than from other parts of the
body. This is a matter which deserves investigation by physiol-
ogists.

The question is, how is this form of effete matter removed
from the body ? I answer that it is removed principally by the
lungs and by the liver. But it may be asked, do the kidneys
remove none of it? A very large percentage of all forms of
living matter, whether vegetable or animal, is water. It is the
special functions of the skin and kidneys to remove water from
the body, and they carry off this water, whether the body is
reduced in weight by sickness or starvation as well as in health.
But it is a well known fact to all physicians of experience that,
except a few forms of disease, as diabetes and some nervous affec-
tions, the quantity of urine eliminated is much less in sickness
than in health.

In all pathological states or conditions, where little or no
food is taken, and where effete matter is being removed from
the solid organism, the kidneys may, and no doubt do, separate
organic substances from the blood, and form or create such sub-
stances as urea, etc. out of the effete matter floating in the blood.
It seems to be the special functions of the kidneys to separate
all foreign substances from the blood. We know how rapidly
they separate bromide of potash from the blood Effete matter,
let it be formed in whatever way you please, is a foreign sub-
stance floating in the blood.

"We speak of men and women being in good health, while there
are very few who are not subject to some irregularity which dis-

The Liver, 113

turbs more or less the proper performance of the functions of
vegetative or organic life. In all of these instances efiete blood
or effete solid matter may exist. A man may weigh a few ounces
less to-day than he did yesterday. The effete matter then formed
is in proportion to the weight lost. In these instances the kid-
neys may remove matter, other than that taken from the food,
from the blood. The foreign substances to be removed by the
kidneys, as the bromide of potash, are things swallowed and
mixed up with the food.

There is nothing more variable than the constituents of the
urine. Sometimes mental emotions, even, will change the quan-
tity of urine and the elements of which it is composed. The
kidneys are capable of separating many things from the blood.
They separate bile from it when the bile is not poured out into
the duodenum after being secreted by the liver; but while they
are yet capable of separating foreign substances, they seem to be
dependent upon the liver for the proper performance of their
functions. You may sometimes force them to act by giving
diuretics, but such medicines do not effect any curative results
in the treatment of disease unless the liver is performing its
functions properly at the same time ; and, according to my med-
ical experience of forty -three years, there is very seldom any
necessity for giving diuretics if you see to it beforehand that the
liver is secreting the proper quantity of bile. I could give
numerous cases treated by other physicians in Kentucky where
patients who had taken many forms of diuretic medicine for
some supposed affection of the kidneys were promptly cured by
taking medicine which acted upon the liver — as calomel ; calomel
and ipecac ; rhubarb, ipecac, and calomel. When the liver does
not perform its functions healthfully, the constituents of the
urine are never such as are found in a person in good health.
When the kidneys do not separate effete matter, or any other
element from the food, which they ought to separate from it, if
you will make the liver secrete bile more freely, you will soon
see in all critical cases that the kidneys are again able to per-
form their proper functions. The all - important difference be-

8

114 The Liver,

tween the offices of the liver and kidneys is this, that so soon as
the urine is poured into the bladder it is of no further use, and
is regularly discharged from the body. On the other hand, the
secretion of the liver — the bile — has several important functions
to perform. These we will now consider.

No man ever saw one drop of pure blood. It is impossible
for the analytic chemist to discover its constituent parts, for he
can not obtain a single drop for his analysis.

No man ever saw a drop of pure water, except a chemist and
those who have seen the results of the chemist's analysis. By
distillation all organic and inorganic substances floating in water
can be separated from it, and we have the thing called water
composed of oxygen and hydrogen in definite proportions; yet
we call it water, whether taken from the ocean, Saratoga, White
Sulphur, or Blue Lick Springs. So it is with the blood.

Physiologists have discovered that food is absorbed under
three forms — glucose, albuminose, and fatty emulsion. What-
ever else may be absorbed along with either one of these forms
they do not know, for they are all immediately mixed with the
blood, which is composed of many elements. In the absorption
of water, spirits, wine, malt liquors, tea, and coffee, I do not
think it has yet been determined whether the absorbent veins
reject any part of them or swallow them all. These liquids are
taken up together with the food. The food and drinks can not
be said to be converted into blood until they have passed through
the portal vein, the liver, the hepatic veins, and the ascending
vena cava on the one hand, and the lacteals, the mesenteric
glands, and the thoracic duct on the other; and then both
through the right side of the heart, the pulmonary artery, and
lungs into the left side of the heart through the pulmonary
veins. I say that the food and drinks can not be called blood
at all until they have passed through the stomach and intestines,
through the glands and vessels referred to, to the aorta. You
can not obtain blood, then, even approximately pure, in the por-
tal vein, in the hepatic vein, in the vena cava, or even in the
pulmonary artery. But this is not all: glucose and fatty emul-

The Liver. 115

sion sometimes pass this round and are found in the arterial
blood. No physiologist disputes this fact. In this round referred
to, the liver and the lungs effect certain changes in the food, but
after it has entered the arterial circulation it has to be subjected
to other eliminating processes which separate from it both or-
ganic and inorganic substances. The special work of the kidneys
is to perform this latter work.

I might refer also again to the functions of the lymphatics,
the spleen, and the skin, but it is unnecessary. This is the state
of things in what we call good health. It is an endless chain.
Food and drinks are being continually poured into the current
of circulation. The conditions under which they enter this circu-
lation is a variable one. Such is the blood in a healthy man.
But let there be wasting sickness, then we have the current of
circulation overcharged with effete matter, and also, it may be,
with blood-poison, as that of smallpox, or scarlet fever, or mias-
matic malaria. Or the food may be unwholesome and badly
prepared by a dyspeptic stomach. Be it as it may, it is this
mixed fluid floating in the veins and arteries, from which the
liver separates bile. But since physiologists have demonstrated,
as they suppose, that the food becomes blood as soon as it is
absorbed from the stomach and intestines ; that what was beef-
steak at breakfast yesterday has become brain and muscle to-day,
and will appear again to-morrow in the form of effete matter,
and that this effete matter is chiefly urea, is it to be wondered at
that they suppose the kidneys to be the most important glands in
the body for the removal of effete matter? ^'The urine is an
.excretion, its constitutent parts are excretions. These constit-
uent parts are derived from the metamorphosis of the solid
organism. These latter are effete matter." Such are the teach-
ings of physiologists. Therefore, say they, the kidneys are the
most important excretory glands in the body. They say a man
can only live so many hours, or a few days at most, without
urinating, but that he can live for many weeks without having a
passage from his bowels. Therefore, say they, whatever is secreted
or excreted by the liver is of very little consequence. They

116 The Liver.

neither know what the bile is made of, nor what are its uses afte;*
it is made. I deny that in perfect health the kidneys separate
effete matter at all from the blood. If they do separate any in
disease it is under particular circumstances; which I will pres-
ently explain.

Effete matter is separated from the solid organism by the
capillaries. That system of vessels is intermediate between the
terminations of the arteries and the beginnings of the veins. In
all of the organs within the abdominal cavity of a man, except
the kidneys and urinary apparatus, the capillaries empty the
effete matter, which they have separated, into the veins, which
carry it directly to the liver. This much of effete matter is
subjected to the action of the liver as it passes through it; it then
passes on through the hepatic vein and vena cava to the lungs,
which glands again act upon it. The effete matter emptied into
the veins by the capillaries, in every other part of the body, is
returned to the right side of the heart by the ascending and
descending vena cava, and it, too, has to pass through the lungs.
In other words, all effete matter has to pass — a part of it through
the liver, and all of it through the lungs, before it enters the
arterial blood. In a healthy condition of the body, these two
glands separate the whole of it from the blood. If they fail to
perform their proper offices, and the liver is frequently unable to
do its work, then some effete matter may enter the left side of
the heart, and be carried from thence to the kidneys.

The lymphatics were, for a long time, supposed to be the only
absorbents. It is now known that they separate from the blood,
or rather from the food floating in the blood, as I believe, highly
vitalized elements, as fibrin, albumen, and white corpuscles. I
think they form them. But if the lymphatics separate effete
matter at all from the blood, we know that they, too, empty their
contents into the ascending and descending vena cava, and thus
the lymph, too, has to pass through the lungs before it enters
the left side of the heart. Urea is found in the lymph. It is a
nitrogen ized substance. The lungs throw off by expiration a
a certain amount of nitrogen. In what particular form it throws

The Liver, 117

it off, I am not prepared to say. The lungs may throw off urea.
Whether or not they are able to separate urea into its elements I
do not know. We all know that the breath from many persons is
terribly offensive. The lungs certainly separate from the blood,
sometimes, other substances beside carbonic acid and water. The
breath of men who are accustomed to smoke tobacco continually,
to drink whisky in large quantities, and to eat onions as they
would cabbage or potatoes, certainly contains something beside
carbonic acid and water.

The purest arterial blood in the body goes to the kidneys,
and the most vitiated blood goes to the liver. The liver is at
all times separating from the blood what ought to be removed.
That is its duty, but the liver does not always do its duty. When
it fails to do its proper work, indisposition, or serious illness is
the consequence. In that state of the case, its near neighbors —
the kidneys — are unable to do their proper work. Indeed, then,
every other organic, vital, animal, and mental power is weak-
ened. What the liver separates from the blood, it forms into
bile. I have already given the composition of the human bile
in Chapter I.

We now copy from Dr. Flint :

*^ Secretion of Bile from Venous or Arterial Blood, — Numer-
ous experiments have been made with the view of determining
whether the bile be secreted from the blood brought to the liver
by the portal vein or from the blood of the hepatic artery. The
immense quantity of blood distributed in the liver by the portal
vein led first to the opinion that the impurities were separated
from this blood to form the bile, and that the hepatic artery had
little or nothing to do with the secretion. This, indeed, was the
view adopted by Glisson, one of the earliest writers on the anat-
omy and functions of the liver. But since Bernard discovered the
glycogenic function of the liver, this subjeet has assumed addi-
tional importance, and it becomes a question whether the mate-
rials for the secretion of bile may not be furnished by one vessel
(the hepatic artery) while the other (the portal vein) is specially
concerned in the formation of glycogenic matter. This theoret-

118 TheUver,

ical view, however, is not carried out by well-established ana-
tomical facts or by physiological experiments. It is not possible
to separate the liver anatomically into two organs, one for the
secretion of bile, and one for the production of sugar. It seems
certain also, from numerous experiments, that bile may be se-
creted from the blood of the portal vein after a ligature has been
applied to the hepatic artery, and it is equally certain, from the
recent experiments of Ore, that if the portal vein be obliterated
so gradually that the animal does not die from the operation, bile
is secreted from the blood of the hepatic artery.^'

" The experiments of M. Ore are very curious and instructive.
After having repeatedly made the experiments of applying a
tight ligature to the portal vein, producing thereby very grave
symptoms and death so speedily that the eflPects upon the secre-
tion of bile could not be satisfactorily observed, he modified his
operations so as to effect a gradual obliteration of the vein. This
he accomplished by simply applying a loose ligature, and tighten-
ing it from time to time till it came away. By this mode of pro-
cedure he succeeded in observing the secretion of bile in six days
or more after the application of the ligature ; and on killing the
animals he found the portal vein entirely obliterated and no
communicating branches by which the blood could get from
the portal system to the liver. From these observations it is
concluded that the bile is secreted from the blood of the hepatic
artery.'^

"In support of this view, several instances of obliteration of
the portal vein in the human subject are cited in works upon
physiology. In a note to the communication of Ore, in the
comptes renduSj Andral reports the case of a patient that died of
dropsy, and on post-mo'rtem examination the portal vein was
found obliterated. In this instance the gall-bladder was found
full of bile. In addition, instances in which the portal vein
emptied into the vena cava have been reported, and in none was
there any deficiency in the secretion of bile."

"In the experiments upon the effects of tying the hepatic
artery and the observations of instances of obliteration of the

The Liver, 119

portal vein and of congenital malformation in which the portal
vein does not go to the liver, be equally reliable, there is but one
conclusion to be drawn from them, and that is that bile may be
secreted from either venous or arterial blood. This view is not
inconsistent with what we know of the general process of secre-
tion and its application to the production of bile. Regarding the
bile as in part an excrementitious fluid, its effete element — cho-
lesterin — is contained both in the blood of the portal vein and in
the hepatic artery. Its re-crementitious principles — glycocho-
lates, taurocholates, etc. — we suppose are produced de novo in the
liver out of materials furnished by the blood. The exact nature
of the production of elements of secretion by glandular cells we
do not understand ; but there is no good reason to suppose that
the principles necessary for the formation of bile may not be fur-
nished by the blood of the portal vein, as well as by the hepatic
artery."

" The views most in accordance with all the facts bearing on
the question is that the bile is produced in the liver by the blood
distributed in its substance by the portal vein and the hepatic
artery, and not from either of these vessels exclusively, and that
the bile may continue to be secreted, if either one of these ves-
sels be obliterated, provided the supply of blood be sufficient."
(Flint, vol. 3, pages 253-255.)

Dr. Frerichs, in his elaborate work on The Diseases of the
Liver, says, "With regard to no organ does history attest a
change of views in a more remarkable manner than in the case
of the liver. This organ and the portal venous system attracted
at a very early period the attention of physicians. More from
vague conjectures than from clearly-established grounds, the seat
of various functions of great importance, both in health and dis-
ease, was transferred to this powerful glandular organ, and to the
extensive system of vessels which is intimately connected with the
gastro-intestinal canal. By the ancients the liver was regarded
as the central organ of vegetative life. Galen looked upon it as
the focus of animal heat, and as the organ intended for the forma-
tion of blood, and for the origin of the veins. According to him

120 The Liver.

the metamorphosis of chyle into blood commenced in the portal
veins, but was completed in the liver, which organ during the
process, separated as waste matter from the blood the yellow and
black bile, the former passing to the gall-bladder, and the latter
to the spleen.

Galen's views underwent scarcely any modifications by the
Arabian physicians, and remained undisputed until the middle of
the seventeenth century. Even Vesalius, who, by his anatom-
ical researches, contributed more than any one else to the over-
throw of the doctrines of Galen, did not venture to oppose his
physiological theories respecting the liver; he only denied the
assimilative property attributed to the portal veiQS.

The attempts of Argentieri to restrict the functional impor-
tance of the organ met with no support. The discovery of the
lacteal vessels by Aselli in 1622, and of the thoracic duct by
Prequet in 1647, first imparted a severe shock to the views of
Galen. A way had been discovered by which the chyle was con-
veyed from the bowel into the blood quite independently of the
portal vein and of the liver ; henceforth neither of these structures
appeared to serve any purpose in sanguification. Bartholin and
Glisson were the first who enunciated in a decided manner this
opinion. It rapidly spread; and the more readily, inasmuch as
the revolutions just effected in the views of physiologists by the
labors of Harvey, bestowed an importance hitherto unknown
upon the organs of the chest. Riolan, indeed, and after him De
Bils endeavored to defend the important part played by the liver
in sanguification in opposition to the views of Bartholin; but
Bartholin came victoriously out of the contest, and wrote for the
liver a humorous epitaph, in which the end of its dominion was
announced, and in which its function was declared to be hence-
forth limited to the secretion of bile.

For almost two centuries this opinion continued generally to
prevail. Swammerdam, it is true, endeavored to advocate once
for the ancient theory, yet with so little success that Boerhaave
observed, ^^Dudum in meliori parte Europce absolevit hcec sanguifi-
i^atio nwnquam ab eo viscere expectanda.'^ It was reserved for the

The Liver. 121

experimental physiology of the present century to extend the
boundaries of our knowledge in this matter, and to reproduce in
a more novel and exact form opinions which, for a long period,
had appeared buried in oblivion. The first step in this direction
was made by Magendie and Tiedemann, who furnished the proof
that the absorption of nutritive matter is not solely the work of
the lacteal vessels, but that a part of the food digested in the
gastro-intestinal canal is taken into the blood through the portal
vein. Tiedemann and Gmelin moreover, by a series of careful
experiments, arrived at the result, tnat " the liver must also be
regarded as the organ for the assimilation of substances which
have been absorbed from the intestines."

The more recent investigators who have paid attention to this
subject, such as Blondlot, Claude Bernard, Lehmann, C. Schmidt,
and others, have been obliged to corroborate the opinion as to
the participation of the portal vein in the absorption of mate-
rials from the intestines into the system, although much remains
doubtful as regards the extent and importance of this participa-
tion. It is to be regarded as clearly proved that the water, salts,
sugar, odoriferous and coloring matters are, for the most part,
conveyed to the blood by venous absorption, as also that the
greatest part of the fat reaches the blood through the lacteals.
But it is still a matter of question in what way the most important,
principles of nutrition — the albuminous — are absorbed. Claude
Bernard, and the majority of the French investigators, make
their absorption take place through the veins, while Lehmann,
Schmidt, and Ludwig are convinced that it is through the lacteals.

Another point which has not been sufficiently investigated is
the influence which the hepatic parenchyma exercises over the
substances which pass through it. According to the experiments
of M. Bernard, Mealhe, and others, the carbo-hydrogens, no less
than the albuminous principles, in their passage through the
portal system, undergo important changes from the action of the
liver, by means of which they first become fitted for the forma-
tion of blood. A detailed proof of this metamorphosis has not,
however, as yet, been given with sufficient clearness.

122 The Liver,

That great thinker, Thos. Henry Buckle, in his History of
Civilization, says, "As these views have a social and economical
importance quite independent of their physiological value, I will
endeavor in this note to fortify them still further by showing that
the connection between carbonized food and the respiratory func-
tions may be illustrated by a survey of the animal kingdom."

"The gland most universal among the different classes of
animals is the liver; and its principle business is to relieve the
system of its superfluous carbon, which it accomplishes by secret-
ing bile, a highly carbonized fluid. Now the connection between
this process and the respiratory function is highly curious, for, if
we take a general view of animal life, we shall find that the liver
and lungs are nearly always compensatory ; that is to say, when
one organ is small or inert the other is large and active. Thus
reptiles have feeble lungs, but a considerable liver ; and thus, too,
in fishes, which have no lungs, in the ordinary sense of the word,
the size of the liver is often enormous. On the other hand, in-
sects have a large and complicated system of air-tubes, but their
liver is minute, and its functions are habitually sluggish. If,
instead of comparing the different classes of animals, we com-
pare the different stages through which the same animal passes,
we shall find further confirmation of this wide and striking prin-
ciple. For the law holds good, even before birth ; since in the
unborn infant the lungs have scarcely any activity, but there is
an immense liver, which is full of energy, and pours out bile in
profusion. And, so variable is this relation, that in man the
liver is the first organ which is formed. It is preponderant dur-
ing the whole period of fetal life, but it rapidly diminishes, when,
after birth, the lungs come into play, and a new scheme of com-
pensation is established in the system."

These facts, interesting to the philosophical physiologist, are
of great moment in reference to the doctrines advocated in this
chapter. Inasmuch as the liver and lungs are compensatory in
the history of their organization, it is highly probable that they
are also compensatory in the functions they perform, and that
what is left undone by one will have to be accomplished by the

The Liver. 123

other. The liver, therefore, fulfilling the duty, as chemistry
teaches us, of decarbonizing the system, by secreting a carbon-
ized fluid, we should expect, even in the absence of other evi-
dence, that the lungs would be likewise decarbonizing ; in other
words, we should expect that if, from any cause, we are sur-
charged with carbon, the lungs must assist in remedying the evil.
This brings us, by another road, to the conclusion that highly
carbonized food has a tendency to tax the lungs, so that the con-
nection between a carbonized diet and the respiratory functions,
instead of being, as some assert, a crude hypothesis, is an emi-
nently scientific theory, and is corroborated, not only l)y chem-
istry, but by the general scheme of the animal kingdom, and
even by the observation of embryological phenomena.

The views of Liebig, and of his followers, are indeed supported
by so many analogies, and harmonize so well with other parts of
our knowledge, that nothing but a perverse hatred of generaliza-
tion, or an incapacity for dealing with large speculative truths,
can explain the hostility directed against conclusions which have
been gradually forcing themselves upon us since Lavoisier,
seventy years ago, attempted to explain the respiratory func-
tions by subjecting them to the laws of chemical combination.

"In this and previous notes I have considered the connection
between food, respiration, and animal heat at a length which will
appear tedious to readers uninterested in physiological pursuits ;
but the investigation has become necessary on account of the
difficulties raised by experimenters, who, not having studied the
subject comprehensively, object to certain parts of it. To men-
tion what, from the ability and reputation of the author, is a
conspicuous instance of this. Sir Benj. Brodie has recently pub-
lished a volume (Physiological Kesearches, 1851) containing some
ingeniously contrived experiments on dogs and rabbits (eighty
years ago Bichat taught the same doctrines as those expressed by
Buckle in the last few sentences) to prove that heat is generated
rather by the nervous system than by the respiratory organs.
Without following this eminent surgeon into all his details, I
may be permitted to observe, that as a mere matter of history,

124 The Liver,

no great physiological truth has ever yet been discovered by such
limited experiments on a single class of animals; and this is
partly because in physiology a crucial instance is impracticable,
owing to the fact that we deal with resisting and living bodies,
and partly because every experiment produces an abnormal con-
dition, and this lets in fresh causes, the operation of which is
incalculable."

I have already referred to the glycogenic function of the
liver. It is repeatedly said by those who pretend to have some
knowledge of physiology, and who claim to be up with the times,
that the glycogenic functions of the liver have been fully estab-
lished by M. Claude Bernard, and it is asserted to be a crucial
test of the truth of this discovery, that if the floor of the
fourth ventricle of the brain be irritated, the glycogenic func-
tion of the liver is excited or increased.

This is an age of music without melody, and of science with-
out thought. If it be a fact, which I doubt, that the irritation
of the floor of the fourth ventricle of the brain causes a larger
amount of sugar to be found in or about the liver, it is a proof
of my theory and not of M. Bernard's. Vivisection or torture
never excited or increased the healthful function of any organ.
I have already referred to the fact that a large amount of glucose
is continually passing, during digestion, from the portal vein
into the liver; and I have affirmed that one of the offices of the
liver is to convert this glucose into something more akin to
blood. The torture, then, inflicted upon the floor of the fourth
ventricle of the brain, would simply arrest the faculty of the
liver to convert the glucose into something nearer akin to blood,
and hence more sugar would be discovered in the hepatic veins.

As Virgil says in his first Eclogue, on his journey from
Padua to Rome, " If we may compare small things with great
ones,'' I would say, that the difference between Lavoisier and
Liebig, as to the production of animal heat, and the theory
which I teach is this, viz. that animal heat is not produced in
any one organ, but that it is generated by glandular action in
every part of the body. The blood found in the hepatic veins is

The Liver, 125

hotter than in any other part of the body, because there are six
systems of circulation going on in the liver, to wit, arterial, two
venous, portal and hepatic veins, lymphatics, biliary ducts, and
nerves. The lungs may approximate the liver in the production
of animal heat, but a large amount of it escapes as latent heat
in the watery vapor expired from the lungs.

I wish the reader to refer to the table of the constituents of
the bile in a former chapter. I think I have shown to the satis-
faction of every one, who allows himself to think, that the sup-
posed discovery of the glycogenic function of the liver by M.
Bernard is one of the results of microscopic examination, to the
exclusion of general laws. I believe that physiologists will yet
come to agree with Bartholin that the function of the liver is
limited to the secretion of bile. But according to my theory
this bile is, in health, for the most part, secreted from the food as
it passes through the liver; and in that sense the liver is an
organ actively engaged in sanguification. Fatty emulsion is
sometimes found in the hepatic veins.

Frerichs, vol. 1, page 196, says, '^Deposits of fat in the tissue
of the liver are amongst the most frequent structural changes
observed in the organ. When this deposit attains a high degree,
we are wont to regard it as a disease, and to designate it by the
name of fatty liver, or fatty degeneration of the liver. All
attempts to sketch an accurate history of this anatomical lesion
from clinical observations have proved unsuccessful; fatty liver
is met wath so frequently on opening the dead body, and all clues
to diagnosis during life are so inaccessible, that it is impossible to
construct a satisfactory symptomatology of the affection."

I am not considering pathological alterations in the liver or
any other organ ; but when 'fatty emulsion even is found in the
blood of the hepatic veins, I consider it to be an irregularity,
and not the normal state of a man in perfect health.

According to Dr. Flint, up to the time of the discovery of
M. Bernard, it was not doubted that bile was secreted from the
portal blood. Since that discovery it is maintained by physiol-
ogists that bile may be secreted from the blood brought to the

126 The Liver.

liver by both the portal vein and the hepatic artery, or by the
hepatic artery alone. Some remarkable facts are given to sup-
port this theory.

We are told that the portal vein has been obliterated, and that
the blood which it carried could not by any possibility reach the
liver, and yet the animal lived. The dogs experimented on are
said to have lived six days or more. It is not stated upon what
kind of food they were fed.

" Communications exist between the portal vein and vena cava
which, when enlarged, convey a large portion of the portal blood
direct to the heart without passing through the liver. In the
first place, there is the anastomosis of the internal hemorrhoidal
with the inferior hemorrhoidal veins, which pass into the hypo-
gastric vein, and likewise the anastomosis of the left coronary
with the esophageal and diaphragmatic veins. More rarely we
find anastomoses of the hemorrhoidal with the vesical veins, of
the coronary vein of the stomach and of the gastro-epiploic veins
with the renal vein, of the superior mesenteric vein with the left
renal vein, and of the vasa brevia with the left phrenic. There
are few direct proofs, however, that these vessels become enlarged
in cirrhosis.^' (Frerichs, vol. 2, page 81.)

If the livers of the dogs whose portal vein had been thus
occluded secreted bile, we can see from the extract just given that
a portion of the blood in the portal vein could reach the general
circulation; indeed it must have done so, or the animals would
have died in a much shorter time. But a case or cases are
reported where the portal vein emptied into the vena cava, and
yet the liver secreted bile. Therefore, say physiologists, bile
may be secreted from arterial blood. In such a case the hepatic
artery is the only blood-vessel conveying blood to the liver.

In the case referred to by Mr. Abernethy, in which the venae
portse did not enter the liver, but terminated in the inferior vena
cava, it was found that the hepatic artery was one third larger
than usual, evidently suggesting the idea that it was in the per-
formance of some unusual office. Besides, the umbilical vein
was still pervious, and branched out into the substance of the

The Liver, 127

liver. In this case the blood would be considerably mixed. It
could not be called arterial blood at all. The liver would, no
doubt, take a much longer time to separate from it a given quan-
tity of bile. The blood conveyed into the vena cava by the
portal vein, in this case, would be carried to the lungs. We
ought to have been told something about the excretions from the
lungs in the case of this remarkable man. Perhaps it would
have been observed that the lungs are capable of separating
many substances from the blood besides carbonic acid and water.

Dr. Flint says, I repeat, "Regarding the bile as in part an
excrementitious fluid, its effete element — cholesterin — is con-
tained both in the blood of the portal vein and in the hepatic
artery. Its recrementitious principles — glycocholates, taurocho-
lates, etc. — we suppose are produced de novo in the liver out of
materials furnished by the blood.^' I do not believe that choles-
terin ever was found in the blood of the portal vein or hepatic
artery in a perfectly healthy person. Cholesterin is manu&ctured
out of the blood by the liver, and by no other organ, just as
urea is manufactured out of the blood by the kidneys, and by
no other organs. If either is found in the blood it is because
they have passed through the glands which secreted or excreted
them, call it which you please.

When the biliary ducts fail to empty themselves into the he-
patic duct on the one hand, or the urinary ducts into the uretery
on the other, then, and only then, both cholesterin and urea may
find their way into the general circulation. But it will be said
that when the kidneys have been removed from the animals an
excess of urea is found in the blood. I will be asked, how is
that formed? I have repeatedly said that urea and all other
excrementitious substances found in the urine of a healthy per-
son are separated from the food floating in the blood by the kid-
neys ; that it is one of the most important processes by which the
elements of the food are converted into blood proper. In disease
I admit that they may and do separate other substances from the
current of the circulation. When the kidneys have been re-
moved the glands remaining to act upon the food floating in the

128 The Liver,

blood — upon effete blood, or effete matter proper — are first the
liver, the mesenteric glands, and the lungs. These act first upon
the fiDod and chyle which have been mixed up with the venous
blood. After the food and the chyle have passed through these
organs they enter the arterial circulation, and are then addition-
ally subjected to the action of the spleen and lymphatic glands.
We know that vicarious functions are performed in the animal
economy. It is one of the methods by which nature relieves her-
self of difficulties. The time may come when some experimenter
will be able to remove the liver from animals. We know that
the brain has been removed from pigeons, and yet they lived for
some days. If the liver were carefully sliced away so as to allow
the blood still to flow from the portal vein to the hepatic veins or
to the vena cava, I do not think it would be as fatal to life as the
obliteration of the portal vein. Should this experiment ever be
successfully performed, it will, perhaps, be discovered that some
other organ is capable of separating bile from the blood. Must
we, then, conclude that the liver is not the gland which secretes
bile? We are told that cholesterin is an excrementitious prin-
ciple or substance, and the glycocholates, taurocholates, etc., are
recrementitious principles or substances. We will notice this
presently.

Dr. Flint says, "The exact nature of the production of ele-
ments of secretion by glandular cells we do not understand."
This may be true, but if physiologists know any thing, they cer-
tainly know this, that secretion or excretion, call it which you
please, is only effected by glands. No other organs secrete.

It would be impossible to conjecture how physiologists can
imagine that the nerves or muscles can secrete such a substance
as urea or cholesterin, did we not know the falsity of the facts
upon which they base their conclusions. I know that Dr. Flint
says, " In the nervous substance and in the crystalline lens, it is
united ^molecule d molecule^ to the other elements which go to
make up those tissues." I can not conceive that he means that
an excrementitious substance or principle can be a constituent
part of a living, healthful tissue ; nor can I suppose that the

The Liver, 129

capillary vessels in separating effete matter from the living
tissues do so separate it in the form of organized substances, as
cholesterin and urea. Cholesterin is found in the meconium of a
new-born infant. Where does it come from ? Those who would
deny the functions of the liver, pretend to say that meconium is
made up of epithelial cells and mucus. They can not stultify
themselves by maintaining that cholesterin, a crystallizable sub-
stance, is made out of epithelial cells and mucus. Nothing,
except, it may be, a little mucus, can pass from the stomach into
the duodenum of the fetus in utero. There is but one other
passage opening into that gut, the ductus communis choledocus.
The existence of cholesterin in the meconium proves two things ;
1. That it, cholesterin, is produced in the liver; 2. That it and
meconium both come from the liver.

The amount of bile said to be produced daily in the body of
a man weighing one hundred and forty pounds, is estimated at
two pounds and a half. Except cholesterin, a very small constit-
uent part of the bile, all the rest is said by physiologists to be
recrementitious. None of its constituent parts, say they, can be
found in the feces. Physiologists admit that they do not know
what becomes of it. But Dr. Flint says that, whether changed
or unchanged, it is certainly reabsorbed. He ought to have
omitted the adverb certainly in making such an assertion. He,
and all other physiologists admit that the constituents of the bile
glycocholate, taurocholate of soda, etc., can not be found as such
in the blood of the portal vein. If they are absorbed they have
nowhere else to go to but back into the portal vein. What a
wonderfully exceptional contradiction in the workings of the
animal economy, for two pounds and a half of a singularly com-
pounded fluid to be poured into an open gut, and that fluid to be
instantly afterward reabsorbed and taken back to the liver, where
the same work is to be performed over again, and this, too, for a
man's whole lifetime ! And this is called science ! I think it
was Dr. Radcliffe, when asked by a young man to tell him
what books to read to become a doctor, who said, "Read Don
Quixote.''

130 The Liver,

On the origin of bile of jaundice Dr. Frerichs says, " Copious
materials have accumulated in the course of time, and theoretical
views of various natures have started up and fallen to the ground
without the most important fundamental questions having re-
ceived a satisfactory explanation/' "In more recent times this
theory has acquired a still firmer foundation, since the chemical
and physical properties of the bile have begun to be examined
more carefully, and since the constituent elements of this secre-
tion have been sought for in vain in the blood of the portal vein,
and likewise of oth^r vessels."

"Zenker and Funke have brought forward fresh arguments
in favor of the intimate relation subsisting between the bile-
pigment and the red matter of the blood, by showing that a
modification of the coloring-matter of the bile, viz. bilifulvine,
can easily be transformed into hematoidin, a derivative of ' hema-
tin.' This would appear to indicate the possibility of a direct
transformation of hematin into cholepyrrhin."

"All the means for detecting traces of the essential elements
of the bile in the blood generally, and in that of the portal vein
in particular, have been exhausted without any result; neither
the coloring-matter, nor the acids of the bile, substances for
which we possess tests of considerable delicacy, have been found.
Even if it be granted that the quantity of bile which circulates
with the blood under normal circumstances is immeasurably
small, owing to the constant performance of the functions of
the liver — in the same way as occurs in the case of the urine —
still this argument is of no weight in diseased conditions, in
which the disorganization of the glandular parenchyma limits
the secreting function, or arrests it to a greater or less degree.
In the same way that urea accumulates in large quantity in
the blood in granular degeneration of the kidneys, so ought
the biliary acids and bile-pigment to accumulate in the blood
in cases of granular liver. Kepeated observations have proved
that this is not the case."

"Still more decided are the proofs of the formation of bile
in the liver, which have been furnished by the beautiful investi-

The Liver, 131

gations of Miiller and Kunde, and likewise of Moleschott. In
the case of the frogs which were kept alive for two or three days,
and by Moleschott for several weeks, after being deprived of
their livers, not a trace of the elements of the bile could be
detected in the blood, the lymph, the urine, or the muscular
tissue. The idea of the preexistence of bile in the blood is
further opposed by the arguments in favor of conversion of cer-
tain elements of the blood into the bile within the liver, which
may be derived from the different composition of the blood in
the portal and hepatic veins. Although the difference of the
blood from these two sources indicated by Lehmann's analyses
appears almost too great to be explained by the act of secretion
it, nevertheless, opens up interesting points for studying the
origin of bile.

"We shall hereafter have an opportunity of adducing fresh
data for obtaining a deeper insight into the mode of origin of
the hepatic secretion, by showing how certain products of meta-
morphosis disappear within the liver. Bamberger considers that
he has found a proof of the preexistence of bile in the portal
vein in the jaundice which is observed to accompany inflamma-
tion of that vessel. The blood of the vena porta, which passes by
the collateral vessels into the general circulation, it is thought,
in such a case produces jaundice by the spontaneous elimination
of the elements of bile. During the past year I have met with
three cases of complete obstruction of the portal vein, and have
availed myself of the opportunity to examine carefully the clot
taken from the vessel. Leucine could be detected in it, but not
a trace of bile pigment."

Dr. Horace Dobell, of London, in a recent essay, says, "We
come next to the special secretion of the liver, that rich, complex,
abundant, and important fluid (the bile) poured out at the rate of
about two pints every twenty-four hours, not less than thirty-nine
fortieths of which is returned to the blood during its passage
through the biliary and intestinal tract — in the course of that
great and important osmotic circulation constantly going on
between the fluid contents of the bowel and the blood."

132 The Liver.

The amount of fluid poured into the intestines and reab-
sorbed in twenty-four hours, says Professor Parkes, "is almost
incredible, and constitutes of itself a secondary or intermediate
circulation never dreamed of by Harvey. The amount of gas-
tric juice alone passing into the stomach and there reabsorbed
amounted, in a case lately examined, to nearly twenty-three im-
perial pints (if we put it at twelve we shall certainly be within
the mark). The pancreas furnishes twelve pints and a half in
twenty-four hours, while the salivary glands pour out at least
three pints ; the amount of the bile is probably over two pints.
The amount given out by the intestinal mucous membrane can
not be guessed at, but must be enormous. Altogether the quan-
tity of fluid effused into the alimentary canal in twenty-four
hours amounts to much more than the whole amount of blood in
the body. The effect of this continual outflowing is supposed
to be to aid metamorphosis; the same substance, more or less
changed, seems to be thrown out and reabsorbed until it is either
adapted for the repair of tissue or has become effete."

As regards that small portion of the bile (not more than one
fortieth of the whole) which is excreted through the intestines,
it acts as a potent antiseptic upon the contents of the bowel,
stimulates peristaltic action, and in this way, as well as by giving
a proper consistence to the feces, assists in their regular dis-
charge, and it rids the system of those waste products of blood
and tissue which can no longer yield up nutriment or force to the
organism. It is a striking fact that all the digestive fluids, from
the saliva downward, promote decomposition until we come to
the bile, which, for the first time, reverses the action and inter-
poses an antiseptic, thus maintaining the status quo of the pro-
ceeds of digestion until they are absorbed or cast off as waste,
and staying the evolution of gases in the passage of this waste
out of the bodv/'

The above detached extracts of two distinguished modern
authors are given to show the views taught to-day by eminent
European writers on the liver and its functions. Dr. Frerichs's
work is an exhaustive one, and contains a great deal of valuable

The Liver. I33

information. These writers do not differ materially from the
distinguished American physiologist to whose writings I have so
often referred.

How comes it that physiologists have endeavored to discover
the origin of the bile from so many different sources? How
comes it that some claim that it is secreted from the blood
brought to the liver by the portal vein; that some claim that
it is formed out of the blood brought to the liver by the hepatic
artery ; that some claim — Dr. Flint, for instance — that it is made
out of both arterial and portal blood; and that some maintain
that the bile preexists in the blood, and is separated from it by
the liver, as the kidneys are supposed to separate the urea which
is constantly floating in the blood ?

Where there is an occlusion of the portal vein, or where that
large blood-vessel empties into the vena cava, every one who
allows himself to think must know that the food and blood
which would have gone to the liver, had there been no occlu-
sion, and when the anatomy of the portal vein is natural, must
finally reach the liver through the hepatic artery. In the case
reported by Mr. Abernethy the hepatic artery was found to be
very much enlarged. Certain it is that that blood-vessel can
not be said to carry pure arterial blood where the occlusion and
malformations exist. The liver acts upon the same materials,
though brought to it by a roundabout and indirect channel.

Aristotle, one of the greatest thinkers and most careful ob-
servers that ever lived, whose doctrines are still potent through-
out Christendom, adopted some absurd notions. Many of his
disciples were unwilling to reject these absurdities, though con-
tradicted by their senses and daily observations. And so it is
to-day. Anatomists and physiologists have examined, with the
scalpel and microscope in their hands, individual organs. Bichat
was the only anatomical and physiological examiner and writer
who permitted himself to generalize.

Modern scientists have come to agree with Galen, who had no
scientific advantages, so-called, that one of the functions of the
liver is that of sanguification. As to how any part of sanguifi-

134 . The Liver.

cation is effected in the liver, they have started several fanciful
theories. They all agree that the liver does exert some influence
upon the food which is continually passing through it, but they
do not pretend to know what that something is. Now, I main-
tain that the something done by the liver is the separation from
the food of certain parts of it, which it converts into bile, and
that that is the larger part of the bile poured out into the duode-
num. I maintain, also, that the liver separates from the blood
brought to it from the portal vein the effete matter coming from
all of the abdominal organs (the kidneys excepted), and that it
converts this effete matter into bile, and that both forms of bile
are excrementitious. It is admitted by every writer to whom I
have referred that the constituents of the bile can not be found
in the blood of the portal vein, and yet, singular to say, they all
maintain that thirty-nine fortieths of the bile is continually reab-
sorbed. I think I have shown clearly that the bile is not formed
from pure arterial blood, nor from any one of its constituents —
like the saliva, gastric, pancreatic, and intestinal juices.

Prof. Parkes says, "Altogether the quantity of fluid effused
into the alimentary canal in twenty-four hours amounts to much
more than the whole amount of blood in the body." I think
this statement is rather wild. I have shown clearly, in a former
chapter, how these several fluids or juices are disposed of by the
lungs, the skin, and the kidneys. The bile ought not to be con-
sidered in the same connection with them. If physiologists could
bring themselves to agree with me, that the bile is formed from
materials which ought to be separated from the food and from
effete matter, then they would be bound to admit that it is an
excrementitious substance. But they have adopted two theories
which stand in the way of this agreement; the first is, that all
of the food, as soon as it is absorbed, goes at once, and always, to
every part of the body to form new tissues ; and the second is,
that effete matter is continually, and always, separated from the
living tissues in the form of urea and other substances. In other
words, they all teach that constructive assimilation and destruct-
ive metamorphosis, or disassimilation, always go on in an animal

Th^ Liver 135

body at one and the same time. They have to dispose of this
eifete or separated matter, and they have selected the kidneys,
particularly, to remove it from the body. They attach no impor-
tance to the teachings of comparative anatomy that the liver and
the lungs are compensatory organs. They all admit, for they can
not avoid it, that the effete matter coming from the abdominal
viscera, whether those viscera are in a healthful or diseased con-
dition, must pass through the liver before it can enter the vena
cava. They will not permit the liver to separate it from the
blood, but allow it to pass on to the left side of the heart, to be
thence distributed to every part of the body, when, after many
rounds of the circulation, the effete matter finally reaches the
kidneys; it is then separated from the blood and passes out of
the body. Finding themselves in such a fog, physiologists are
compelled to maintain that thirty-nine fortieths of the bile is
reabsorbed. The denial that the bile is formed from the food,
and from effete matter, involves the doctrine that it is a recre-
mentitious and not an excrementitious substance ; that conclusion
necessitates the absorption doctrine; that doctrine gave rise to
the theory of Claude Bernard that the special function of the
liver is to create sugar and fats. These conclusions, taken alto-
gether, led many physiologists to believe that the bile preexists
in the blood, and that it is only separated from the blood by the
liver, as they all teach in regard to urea and the kidneys.

Dr. Dobell attaches much more importance to the functional
uses of a fractional part (one fortieth) of the bile than does
Dr. Flint and many other physiologists. They find cholesterin
changed in stercorin in the feces, and therefore they admit that
it is not absorbed. My doctrine is that it is all excrementitious,
and that it all passes off from the body with the feces. It gives
to them color, odor, and consistency. In fevers and other ail-
ments it is the duty of the physician to examine the alvine
evacuations, though that is nowadays seldom attended to. The
bile is poured into the duodenum and mixed with the food
before it is absorbed. That it exerts some influence upon the
food preparatory to absorption, I do not doubt. We all know

136 The Liver,

that a large proportion of what we eat, even in perfect health, is
not absorbed, but that it passes off from the bowels as fecal mat-
ter. This is a quantity which physiologists have not taken into
their calculation, when they balance the injesta with ejesta in the
body of a man which is entirely changed within twenty days.
The bile unites with that part of the food which is not to be
absorbed, and passes with it from the body. The Gulf Stream
passes through the Atlantic Ocean without mixing with the waters
on either side of it, and in the same manner the River Rhone
passes through the Lake of Geneva. In the same manner the
current of bile may pass through the food which it finds in the
duodenum. As physiologists can present no proofs that the bile
is reabsorbed, they have to resort to an argument to maintain
their doctrine that it is not excrementitious. They say that a
man can only live a few days if the kidneys fail to perform their
functions, but that a man may live for a week or more without
any alvine evacuation. Now, I maintain that the bile passes off
with the ^ases. It has been a wonder to me that all physiolo-
gists, especially the French, who hardly ever omit to notice any
thing, have all omitted to notice one of the excretions from the
living body. I mean the gases wdiich escape from the bowels.
Were a balloon ever so large not more tightly tied than the
sphincter ani, which prevents the escape of gases from the rec-
tum, it would soon collapse. For the most part this exit of gas
from the human body is without noise ; but from the loudness of
the report which is sometimes heard one might suppose the quan-
tity of gas discharged was sufficient to fill a gas-bag holding sev-
eral gallons. Were a bag of sufficient size attached to the anus
of many individuals, and they were thrown into the sea, it would
be found that they could not sink. The gases thus escaping from
the human body are often villainously offensive. When they have
been analyzed physiologists will no longer be at a loss to know
what has become of the constituents of the bile. The absorption
theory of bile will then be exploded.

It has been estimated that a man weighing one hundred and
forty pounds throws off from the lungs by expiration eleven

The Liver, I37

ounces of solid carbon daily. I do not pretend to be accurate
about this. It is certainly a very large amount. Considering
the many wonderful experiments which are being made on living
animals, it would not be difficult to measure accurately both the
quantity of gas which escapes from the bowels and also the solid
constituents. These gases are continually escaping and carrying
off with them a quantity of solid matter sufficient to account for
a large amount of the materials of the bile which physiologists
have not been able to discover in the feces. The offensiveness
of bed-chambers not well ventilated, and of crowded school-
rooms, and of public halls is caused, I think, not so much by the
air being breathed over and over again as by the gases to which
I have referred.

Has any man ever yet made an investigation to find out the
quantity of gas which escapes from the bowels of a man who has
no other alvine discharge ? It has been the disagreeable task of
many physicians to remove scybullse from the rectum of these
costive persons. These hard balls prove that some other dis-
charge has been continually going on. We also find that in some
forms of bowel affection a loud discharge of gas from the rectum is
the first sign of improvement in the condition of the patient. It
is a healthy function as well as an important one. There are some
expressions concerning it among the common people which are as
forcible and true as are the anecdotes of President Lincoln.

Dr. Dobell says, "The amount of fluid poured into the
intestines and reabsorbed in twenty -four hours, says Professor
Parkes, is almost incredible, and constitutes of itself a secondary
or intermediate circulation never dreamed of by Harvey."

This osmosis is referred to by Dr. Flint. According to my
limited knowledge of anatomy, and of physiological laws in
healthy bodies, I did not know that any fluids ever escaped from
arteries, veins, and lymphatics, except so far as to moisten and
lubricate the peritoneal coat investing all the viscera within the
cavities of the chest and abdomen. The cuttle-fish when attacked
is said to color the waters surrounding him. Physiologists have
resorted to this osmosis doctrine for the same reason.

138 The Blood.

CHAPTER VIII.

The Blood.

If a Lilliputian physiologist had told Gulliver that the blood
was formed in the marrow-bones, Swift would have eclipsed
Lesage and Moliere in sarcasm on the medical profession; yet,
wonderful to tell, a distinguished physiologist in the latter part
of the nineteenth century has announced such to be the probable
fact.

Dr. Flint, in his very learned work, has given some space to
the consideration of this new doctrine. Shades of Bacon ! What
sort of philosophy do you call this? Do you call it the induct-
ive or deductive? In comparison with such authorities, Samuel
Thompson, the author of the steam-doctor system, was a Syden-
ham in medical science.

The same reasoning that led this distinguised savan to sup-
pose that the red blood corpuscles are generated in the marrow-
bones, caused some of the most distinguished physiologists of
to-day to imagine that the bile was generated in the blood, as it
circulates through the arteries, capillaries, and veins. When one
false quantity occurs in a calculation, it is impossible to arrive at
a correct result; but when half a dozen occur, the doctrine of
probabilities itself could not unravel the mystery. Common
sense is excluded in both instances.

The microscope has developed infinitesimal mice into moun-
tains of error. The blood is formed in no particular part of the
body and by no special organ. It is formed from, and out of, the
food. All the glands which empty their secretions into the mouth,

' The Blood. 139

the glands which secrete the gastric juice, the pancreas, and the
glands which secrete the intestinal juices, are engaged in its
first preparation. These prepare the food for absorption. Phys-
iologists say that the food is absorbed in the form of glucose,
albuminose, and fatty emulsion. They detect these substances in
the portal blood, and one of them in the lacteals. Whatever
else is absorbed, or may be absorbed, they do not know, because
the blood is a mixed fluid, and it is difficult to tell what is blood
proper, from what has been recently absorbed from the stomach
and intestinal canal. The only pure blood that I can conceive
of would be that taken from the artery of a strong, healthy, vig-
orous infant, shortly after birth and before it has sucked. After
the child sucks, and before it begins to eat common food, the
blood would be comparatively pure. But in grown-up men and
women, the blood is so continually mixed up with the food that
it would be the next thing to impossible to find a standard pure
blood. I should suppose that twelve or fifteen hours after a
perfectly healthy person had eaten would be the best time to find
it. The purest blood would then, probably, be found in the
renal veins, and in the veins of the spleen, just as they come out
of that gland.

The absorption of food is but the beginning of the formation
of blood. The food has to be subjected to the transforming
action of the liver and mesenteric glands. This is the first step
after absorption. It is then mixed with the lymph from all parts
of the body, before it enters the right side of the heart. It next
passes to the lungs, where it is intermixed with the nitrogen
and oxygen inspired. The liver and the lungs not only trans-
form the food, to a certain extent, into blood, but they also
separate from the food certain substances which they throw ofi*.
In the one case it passes off in the form of bile, in the other in
the form of carbonic acid and watery vapor. After the food has
passed through the liin^s, it enters the left side of the heart
intermixed with the arterial blood. But the process of convert-
ing food into blood is not yet ended. All that which is sent to
the splefen — we mean the food, and it is a large quantity— is sub-

140 The Blood.

jected to a transformative process, in that gland, without having
any thing separated from it. That very great and all-important
changes are effected in the spleen, we have no doubt. The fact
has been noticed that the quantity of albumen aud fibrin is
increased as the blood passes through the spleen. It is most
reasonable to suppose that the spleen vitalizes, so to express it,
in a high degree the food as it passes through it, because the
blood which flows from the spleen is immediately mixed, in the
one case — that is, during digestion — with the food freshly ab-
sorbed ; and in the other case — that is, when digestion may be
said to be completed — with blood which has been impoverished
by passing through the abdominal capillary system, and which
is returning slowly to the heart as venous blood. Such blood
requires the rejuvenating influence of new blood coming from
an organ which is so wonderfully elaborate in its mechanism.
But another large portion of the food is sent to the kidneys.
It is the office of these organs to separate from the food certain
substances, which neither the liver nor the lungs could separate
from it. These substances are what are found in the urine of a
perfectly healthy person. I have before alluded to, what may
be called, elective affinity. It is only a conjecture which, I
think, may be worthy of consideration. The supposition is that
certain ingredients of the food may go directly to the kidneys,
as well as to the skin, for separation. The skin throws off a
large quantity of the fluids with which the food is mixed, before
it is absorbed, besides a certain quantity of the watery part of
the lymph with which all the food is mixed before it enters the
right side of the heart. But the food which has recently entered
the circulation, does not all go either to the spleen or kidneys
after it leaves the left side of the heart. It is carried along by
different channels to every part of the body. Before reaching
the capillary system of blood-vessels, it is subjected to the lym-
phatics, which accompany the arteries from their minutest rami-
fications. It is the office of these lymphatics to separate certain
portions of the food, thus distributed over the whole body from
the current of the arterial blood, and to subject it to the trans-

The Blood, 141

formative action of the lymphatic glands. The older physiol-
ogists, I believe, considered the lymphatics as the absorbents
proper, and supposed that they removed effete matter from the
solid organism. I am not here considering the functions of the
lymphatics in pathological conditions. I think that they act
especially upon the food floating in the arterial blood. I know
that urea is found in the lymph. I do not believe that urea is
ever a constituent part of the blood of a perfectly healthy indi-
vidual. I have before said that I think it sometimes escapes
into the venous blood coming from the kidneys, when the ducts
coming from the glands of those organs fail to pour it all into
the ureters, just as the bile is sometimes poured into the hepatic
veins, which ought to have gone into the gall-bladder or the
duodenum.

It is so seldom that any human being can be called perfectly
healthy that it w^ould be almost impossible to say when there may
be, or may not be, effete matter floating in the blood. In the
training of race -horses and athletes there is waste or loss of
weight in their bodies. This waste passes into the veins as effete
matter. When there is effete matter in the blood, it may be a
question whether the lymphatics have the powder to form urea
out of it. In pathological states they may exert that power
vicariously, but I do not believe that they ever convert effete
matter into urea when the kidneys perform their normal func-
tions healthfully. Physiologists, so far as I have been able to
inform myself, have no definite knowledge as to the office or
functions of the lymphatics in the animal economy. Nor have
they, I think, any better knowledge of the uses of the lymph
itself. The food is either converted into solid tissue immediately
after its absorption, as taught by physiologists generally, or it is
subjected for many hours to the action of all the glands referred
to above in its transformation into blood. This is my belief.
After its absorption it is subjected to the action of certain
glands already referred to. But inasmuch as a large portion
of the blood, carrying the food along with it, does not go imme-
diately to these glands, but is distributed to all parts of the body,

142 The Blood,

ought it be thought strange that a particular system of absorb-
ing vessels — the lymphatics — should accompany the arteries dis-
tributed over the whole body, with the duty imposed on them of
absorbing the food floating in these arteries, and of subjecting it
to the transformative power of their glands? I have said that it
was the office of the spleen to pour into the portal vein contain-
ing the food recently absorbed, or containing blood somewhat
impoverished, what I assume to call rejuvenated blood. The
lymph is known to contain in large quantities highly vitalized
principles. This lymph is mixed with the oily and fatty portions
of the food as soon as its enters the thoracic duct. In both
instances during digestion we have in one case fresh blood from
the spleen mixed with the food, and in the other a highly elabo-
rated fluid — the lymph — mixed with another portion of the food.
These intermixtures constitute one link in the chain for the con-
version of the food into blood. I believe the blood is formed in
transitu by the action of the various glands already referred to.
The white blood corpuscles antedate the red disks. Physiolo-
gists may be able to discover the glands which perform the most
important part in the fetal life, so to express it, of white and red
blood corpuscles. They have not yet been able to do it. What
is the period of life of these corpuscles, perhaps, can never be
determined. No doubt, after a shorter or longer time, they are
thrown ofi^ from the body. When that time comes they form a
part of what I call effete blood.

I have presented in the foregoing pages what I believe to be
a correct view of the secretions and excretions. Excepting those
concerned in generation and reproduction, the secretions and
excretions are wholly and exclusively concerned in the conver-
sion of food into blood, and of this blood, during growth, or
when the body is increasing in weight, into solid organized tis-
sues. This is the labor of life, so far as the vegetative and organic
processes are concerned. After the food has been converted into
blood, each tissue (I again mean the tissues of Bichat^ — muscle,
bone, etc.) selects from the blood the parts of it necessary to per-
fect its organism and to repair waste, when there is any waste.

The Blood. 143

This conversion of food into blood causes corresponding motion,
which motion evolves animal heat. Animal heat, during good
health, is generated in all parts of the body wherein there is
motion. This is the explanation why men living in warm cli-
mates eat comparatively little food, and only such food as requires
little labor or motion in converting it into blood. On the other
hand, it explains why men living in cold climates eat very large
quantities of food, and such food, raw meats, oils, and fats as
requires long-continued labor and motion in the conversion of
them into blood.

That the nervous system is largely concerned in all the pro-
cesses of digestion there can be no doubt. In man, who may be
called the most highly developed animal, each system and sub-
system is dependent the one on the other. That the first impres-
sions, and the most powerful which can be made upon man, are
made through the nervous system, I think there can be no ques-
tion ; but to produce healthy nervous fluid there must be healthy
or pure blood. A healthful and vigorous condition of the nerv-
ous system can not exist unless the system of vegetative or
organic life is also in a healthy state. So, likewise, a disturbed
condition of the nervous system may, and often does, interfere
with or interrupt the organic and vegetative system.

144 - Hyperemia and Congestion,

CHAPTER IX.

Hyperemia and Congestion.

These two words, hyperemia and congestion, are used as syn-
onymous terms by both Drs. Dalton and Flint in their learned
and elaborate works on Physiology. They are constantly so used
by medical writers generally. Venous congestion is always, in
my opinion, a pathological state. Arterial congestion, or hyper-
emia, may exist under both a physiological and a pathological
condition. Arterial congestion may exist pathologically in the
formative stage of inflammations, and in fevers, but the fullest
expression of hyperemia, in the proper sense of that word, is
expressed in the blush on a maiden's cheek and in the orgasm
of erectile organs, both of which are physiological conditions.

Hyperemia, in my opinion, should never be applied to venous
congestion. The doing so causes confusion. The word should be
restricted entirely to mean a purely physiological state or condi-
tion. When we mean to speak of arterial congestion under patho-
logical conditions, we should so express it. We should not in
such a case use the word hyperemia. There is, in my opinion,
no pathological condition so little understood and about which
there are so many confused opinions as venous congestion. John
Estin Cook, M. D., the distinguished professor of the theory and
practice of medicine in Transylvania University, at Lexington,
Ky., was the first man who ever understood fully what venous
congestion means. He was certainly the first medical writer who
made the thing intelligible. It would be impossible for me to do
better than copy exactly and literally what he has written upon

Hyperemia and Congestion, 145

the subject. The extracts will be found in the second volume
of Cook's Pathology and Therapeutics, beginning at page 3 and
paragraph 1209, and ending at page 13 and paragraph 1250,
inclusive :

" 1209. In the preceding pages we have seen that weakened
action of -the heart is one link of the chain of causes and effects
extending from the remote causes to the symptoms of fever
(18, 691). The next question in the prosecution of this inquiry
(19) is, what is the effect of this cause, weakened action of the
heart?

"1210. One consequence immediately flowing from weakened
action of the heart, is the diminution of the quantity of blood
sent into the arteries ; whence follows, first, weakness of the pulse,
a very obvious consequence of the diminution of the power which
distends the arteries; second, paleness and coldness of the sur-
face, consequences as certain of the failure of the usual supply
of blood to the surface; third, diminished bulk of the external
parts, shrinking of the features, and shriveling of the skin, all
necessarily following deficient fullness of the cutaneous and sub-
cutaneous vessels. Weakness of the pulse, paleness, and cold-
ness of the surface, and diminished bulk of the external parts,
shrinking of the features, and shriveling of the skin, are there-
fore immediate consequences of diminished action of the heart.
There is another consequence of this state of the heart, very
extensive in its operation on the human system.

"1211. The heart is an exceedingly strong muscular cavity,
which receives the blood from the veins, and impels it with great
force and velocity into the arteries.

"1212. The arteries are firm elastic tubes, the greater part of
them firm enough to retain the form of a tube when empty. At
every contraction of the heart the blood is forced into them,
whereby they are distended; but they have the power of con-
tracting so forcibly as immediately to overcome the distension.
This distension, is sometimes visible. It may be seen in the tem-
poral artery in those thin persons in whom that artery is very
prominent, running, as it were, above the level of the neighbor-

10

146 Hyperemia and Congestion,

ing skin. It may be distinctly ascertained by feeling the radial
artery when the pulse is strong. At the moment of distension
the artery is felt to swell out to the fingers, and immediately
after to retire from them ; and this is the case when the artery is
so strictly confined between the radius and the fingers that very
little more pressure will obstruct the passage of the blood, so
that the artery is incapable of any departure from the straight
line. The arteries have the power of expelling the blood con-
tained in them, when the heart ceases to act, so that after death
they are found empty. I have seen the external iliac so closed
as to require the insertion of a probe to show the cavity.

"1213. The veins are flaccid vessels, exerting little force on
their contents, and readily yielding to a distending force.

"1214. The divisions and minute subdivisions of the arteries
and veins penetrate every part, and constitute a large portion of
every structure, and almost the whole of some, as the glands.
Through these numberless vessels the blood, with great force and
rapidity, is necessarily driven ; a mass equal to the whole quan-
tity in the body, passing from the arteries to the veins many
times every hour. The heart propels the blood into the arteries,
the arteries propel it into the veins, which slowly return it to
the heart. Whilst the heart acts vigorously the vital stream is
passed on as fast as it presents itself; but as soon as the action
of that organ is diminished, less is received, and the great veins
are distended. If the diminution of the action of the heart be
sudden, in a little time the accumulating blood presses on the
heart and stimulates it to increased action, whereby the evil is
sometimes remedied. But the continued operation of the causes
in force sufficient to produce continued weakness of the action
of the heart produces continued fullness of the great veins.

"1215. Early in life the balance of the circulation is main-
tained by the activity of the heart ; but as soon as it begins to
flag, the scale is turned against the veins. As age creeps on,
venous plethora becomes more and more apparent ; and when the
action of the heart ceases in death, the veins are found full, the
arteries empty.

Hyperemia and Congestion, 147

"1216. This is not the effect of age alone.. In every period
of our existence, when disease puts an end to the action of the
heart, the result is the same. The vena cava is found full.

" 1217. Nor is it the effect of disease. In all the vigor of life,,
if by any operation the action of the heart be stopped, the imme-
diate consequence is the same. ^ When the breast of a living dog:
is opened by taking away the sternum with the cartilaginous
appendices of the ribs, the lungs are observed suddenly to sink,
and afterward the circulation of the blood and the motion of the
heart to cease. In a little time after that the right ventricle of
the heart and the vena cava are swelled as if they were ready to
burst.'

"1218. The effect of weakened action of the heart, therefore,
is accumulation of blood in the great veins entering into it.

"1219. As the latter is the consequence of the former, that
which indicates the former indicates also the latter. We have
before seen (82, 83) that a pulse smaller and weaker, and a sur-
face and extremities paler and cooler than usual, indicate weak-
ened action of the heart — these symptoms, therefore, also indi-
cate accumulation of blood in the vena cava and its branches.

" 1220. As this accumulation necessarily extends to the great
branches of the cava, let us inquire how far it extends and what
branches are readily filled.

'^1221. The veins have but little action; they derive assist-
ance from various sources to enable them to pass on their con-
tents. As in different parts of the system this is more or less
effectual, or as they are more or less disposed to yield, accumula-
tion of blood to a greater or less extent must take place.
' "1222. The veins of the fleshy part having the benefit of
almost perpetual action of the muscles, and of the aid of valves,
to prevent regurgitation and to give the more complete effect
to the muscular pressure, the blood has but little opportunity
to accumulate in them, but is incessantly driven to the interior
of the body.

"1223. The vena cava, and its branches between the last
valves and the heart, being destitute of those aids which in Other

148 Hyperemia and Congestion.

parts help the blood along, must be the chief seat of venous
plethora.

" 1224. This great cavity consists of the vena cava, the exter-
nal iliac, and the crural veins, the hypogastric or internal iliac
veins and their branches, the hepatic veins and their branches,
the vena portse and its branches, the renal veins, the subclavian
veins, and the internal and external jugular veins.

"1225. The veins of the arms escape from among the muscles
near the head of the humerus, and joining with others from the
neighboring parts, form the subclavian. This point is the limit
of the cavity in this direction.

"1226. The veins of the head, internal and external, includ-
ing the sinuses of the brain, have no valves ; and therefore the
cavity in this direction extends to the origin of the veins, and
includes those passing from the glands about the head. These
all have free communication with one another, and with the cava
through the subclavian vein.

"1227. The cavity is limited by strong valves at the mouth
of the azygos, the next considerable vein entering the cava.

"1228. The coronary veins of the heart are in like manner
strongly guarded.

"1229. The hepatic branch of the venous cavity i$ very ex-
tensive. The vena portse, which, ramifying in the liver by the
reunion of its numberless branches, forms the venae hepaticse, is
composed of three large veins, besides some minor ones from the
stomach, the duodenum, and the gall-bladder. These are the
greater mesenteric, the splenic, and the internal hemorrhoidal or
smaller mesenteric veins.

" 1230. The greater mesenteric vein is formed of the numer-
ous vessels which return the blood from the small intestines, the
cecum, the right portion of the colon, the pancreas, and the
omentum. By the convergence of all these is formed an immense
assemblage of veins of very large size in the mesentery, which
anastomose in the freest manner. It is difficult to realize their
number and their size without examining a good preparation.

"1231. The splenic vein carries into the vena portse the blood

Hyperemia and Congestion, 149

sent to the spleen, a very considerable quantity. The size of this
vein in comparison with the artery is peculiar; its trunk is to
that of the splenic artery in the proportion of five to one, and
consequently there is a proportionate slow motion of the blood
in the veins.

"1232. The internal hemorrhoidal or smaller mesenteric is
formed of the veins which return the blood from the upper part
of the arch and the left portion of the colon, and from the whole
of the rectum. Even these remote branches are a part of the
venous cavity. When the smaller mesenteric vein of a subject
having piles is dissected the ramifications terminate in these
pouches of blood. Hence the mortal hemorrhages from these
small tumors which have occasioned so much surprise.

"1233. The structure of this extensive system renders it in a
remarkable degree liable to suffer accumulation of blood. The
coats of the veins, especially those of the spleen and liver, are
weak, and exert little force on the fluid contained in them ; they
are little assisted by muscular action ; they have no valves ; their
great peculiarity, the subdivision of the vena portse in the sub-
stance of the liver and the reunion of its small branches into
large veins, called hepatic, promotes accumulation of blood in
them. In every other part of the system this fluid, after having
passed through one set of veins, receives anew the impulse of
the heart. Here it passes through two additional sets before it
has that advantage. Hence the blood is, in these vessels, ex-
tremely sluggish in its motion.

"1234. The large but short renal veins also form a part of
the venous cavity.

"1235. The hypogastric or internal iliac veins are very large
branches of the cava; the internal iliac artery carrying into the
pelvis nearly as much blood as the external iliac does to the
lower extremities.

"1236. The uterine branches of these veins are large and
capable of extraordinary dilatation. Wistar says the veins of
the uterus, during gestation, are in some places more than half
an inch in diameter.

150 Hyperemia and Congestion,

" 1237. Other branches of these veins return the blood^from
the whole substance of the back part of the pelvis, viz. the
parts within and without, and from the cavity of the bone
itself.

"1238. The external hemorrhoidal veins are branches of
these, and when distended constitute the external piles. Thus
the piles, whether internal (1232) or external, are portions of
the venous cavity.

" 1239. This branch of the great venous cavity lies lower than
any other part of it, except the lower extremity of the exter-
nal iliac vein; and is therefore pressed by a great weight, the
pressure of a column of fluid being in proportion to its height.
Freely communicating with the cava, it partakes of its fullness
whenever the blood accumulates in that great vein.

"1240. A short distance without the abdomen, a considerable
number of veins from the large muscles of the leg and thigh
uniting, form the crural vein, which, in proportion to any of the
rest, is quite large; and after entering the abdomen takes the
name of external iliac vein. The smaller branches which form
the crural vein, being exposed to the constant action of the
strong muscles of the thigh, and having the aid of valves, are
not liable to partake of any ordinary degree of fullness of the
vena cava. Here, then, is the limit of the venous cavity in
this direction.

"1241. These branches of the cavity vary much in their dis-
position to yield, and in their sensibility under venous plethora.
The hepatic is the weakest in its structure, and most apt to yield.
The veins constituting the bulk of the liver and spleen have
been so excessively distended, and thereby weakened, that these
viscera, on being taken out of the body immediately after death,
have been found unable to bear the weight of their contents and
have fallen in pieces from the hands of the operator. The
uterine branch of the hypogastric vein is capable of great dilata-
tion ; but the head is most sensible to fullness of its veins.

"1242. This is not always found to be the relative disposition
in the different branches of the venous cavity, to yield to the

Hyperemia and Congestion, 151

accumulation of blood. In some instances the veins of the head
give way more readily than usual. In others, the uterine veins,
though ordinarily much disposed to yield, are extremely rigid.
In a third set, you may find the liver or spleen habitually tumid,
and, when reduced to the ordinary size, prone to become large
again.

" 1243. In order to have a distinct idea of the cavity, let us
suppose the action of the heart suddenly to cease. The check
given to the blood would instantly produce distension of the
cava (1218), which would, in every successive moment, dilate
successive portions of that vessel and its branches till the valves
were raised. It is evident that at this moment the regurgitated
blood would distend the cava, the internal and external jugular
veins, the subclavian, the hepatic, the renal, and the hypogastric
veins, and the external iliac and crural veins; and that access
would be denied to it, into the veins of the limbs, and into the
azygos, and the coronary veins to the heart.

'^1244. The following dissection of a child five or six months
old was made with a view to this subject. The ribs, sternum,
and clavicles, the integuments and muscles of the arms and
legs, the diaphragm, the mediastinum, the stomach, were all
cut away, so as to show the whole of the veins from the calf
of the leg and the upper part of the arm into the cava and
the whole course of the cava ascendens and descendens with
the subclavian veins. It was, when thus laid open to view, at
a single glance apparent that the right side of the heart, the cava,
the subclavian veins, the iliac, the crural, and the deep veins
running along with the femoral artery down as far as the calf,
were full of black blood. The veins were so full as to retain the
round shape, and were stuffed full to the valves near the head of
the humerus, at which point the stuffed appearance ceased sud-
denly; and immediately at the termination the vein returning
from the arm was empty, flaccid, and transparent, so as scarce to
be perceived by candle-light. On pressing the blood of the full
venous cavity toward the stuffed end at the head of the humerus,
it would not pass into the vein beyond the valves; but on increas-

152 Hyperemia and Congestion,

ing the pressure, it was forced out of the minute veins, entering
into the subclavian from the skin and other neighboring parts,
which had been cut across in laying bare the subclavian vein,
and which were so minute as not to let the blood pass till press-
ure was made. The venous cavity was here shown in its exact
shape, etc. The azygos had blood in it, but was quite small.

"1245. Though this cavity be the special seat of venous
plethora, there are cases in which the gradual accumulation of
blood is such that all the veins of the body are distended. In^
some of these cases the veins even on the back of the hand are
singularly prominent, and so distended as to be quite round.

" 1246. In some cases, too, when in consequence of general
plethora and great inaction, pregnancy, or other obstruction, the
column of blood in the saphena so distends that vessel that its
valves are no longer capable of meeting and closing the passage.
This venous trunk has no barrier between it and the venous cav-
ity, and becomes a part of it.

"1247. It is evident that repeated distensions of the venous
cavity must lessen its tone and render it more liable to yield in
future and even to remain permanently enlarged; and that this
enlargement must especially affect those parts that are particu-
larly lax in their structure; as the vessels of the liver, the spleen,
and the uterus.

"1248. Accumulation of blood in the venous cavity being
the effect of weakened action of the heart, is another link of
the chain of causes extending from the remote causes to the
symptoms (18). The question is (19), what are the effects of
this cause, accumulation of blood in the venous cavity ?

"1249. Before we proceed, however, some things must be
noticed which produce this link of the chain of causes, and are
therefore remote cause of fever (1204).

"1250. The suppression of customary evacuations is an obvi-
ous cause of fullness of the vessels, which, if the action of the
heart continue the same, must center in the venous cavity.''

Dr. Cook's book is out of print. The first volume is devoted
to the explanation of his views as to the miasmatic or malarial

Hyperemia and Congestion, 153

origin of fevers and other maladies. Of this part of his work
Dr. James Conquest Cross, a distinguished teacher of medicine
in the Medical College of Ohio at Cincinnati, and afterward in
Transylvania University, said that it was useless for any man
ever to attempt to write any thing further upon the malarial
origin of diseases, because Dr. Cook had exhausted the subject.
Not one in ten thousand of the medical men of to-day ever saw
a copy of Dr. Cook's work, and yet thousands of medical writers,
considering the question from various standpoints, declare mala-
ria to be the remote cause of many maladies. Their views and
opinions were anticipated by Dr. Cook over sixty years ago.
He has clearly explained what they so vaguely understand.
Since his day Daniel Vaughan, of Cincinnati, has written the
only essay on this subject which is worth any thing. His essay
was published some years since in the Dublin, Edinburgh, and
London Philosophical Magazine, and afterward in the Cincinnati
periodicals.

If any one will read Dr. Murchison's valuable little work on
Functional Derangements of the Liver, he will find that Dr.
Cook has, in his second volume, anticipated him almost in every
particular, and explained the doctrines taught by Dr. Murchison
much more clearly and distinctly than Dr. Murchison was able
to do in his own book.

The above extracts from the works of Dr. Cook have been
submitted to one of the ablest teachers of anatomy in the United
States, who is also one of the most distinguished and successful
physicians and surgeons in this or any other country. He says
that the anatomical and post-mortem facts observed and noted
by Dr. Cook are exactly and positively true.

I hope the reader will give the closest attention to them, and
study them well before he proceeds further. There is no under-
standing of disease, and particularly of the uses of emetics and
cathartics, without a knowledge of congestion as explained by
Dr. Cook. This applies more particularly to the action of the
liver, the removal of effete matter, and to the therapeutical
effects of calomel. Without this knowledge of congestion

154 Hyperemia and Congestion,

neither the action of the liver in certain forms of disease, the
removal of effete matter, nor the curative uses of calomel can
be understood.

As remarked by Dr. Cook, and as known by every body
acquainted with the subject, the arteries are found empty after
death, and the veins filled with blood. This shows how disten-
sible the veins are, and that they are capable of holding all the
blood in the body. It is because of the fact that the arteries are
found empty after death that they were supposed to contain air
during life, which was the popular belief until Harvey discov-
ered the circulation of the blood.

This excessive fullness of the veins with a lesser quantity of
blood in the arteries can only be approximative during life. The
more prolonged and complete the weakened action of the heart
is, the more excessive will be the congestion of the vena cava
and its branches. As long as the action of the heart is con-
tinued, some blood is distributed through the arteries to all
parts of the body. Of course there is a corresponding return
of blood through the veins to the heart. But so long as there
is vitality enough left for the valves within the veins to act, all
veins having valves empty themselves, and are not, and can not
be, the subject of venous congestion.

Hence it is that while the veins within the cavities are con-
gested, as explained by Dr. Cook, those upon the surface are
comparatively empty, carrying off only the small quantity of
blood brought to them by the arteries. The fullest expression
of this internal congestion, particularly of the abdominal vis-
cera, with the comparatively empty condition of the superficial
veins, is found in the collapse of cholera.

If a dam is built across a creek or a little river, the bed of the
creek or river first fills up with water, after that all the little
rivulets which empty into this pond or lake become filled to some
extent with the back water which ascends their descending cur-
rents; so it is also, as explained by Dr. Cook, with the veins
having no valves, which 6mpty into the vena cava. The seat
of this congestion, as also explained by him, is particularly in

Hyperemia and Congestion. 155

the abdominal and pelvic viscera and within the cranium. Ex-
cessive congestion of the internal and external jugulars, and of
the sinuses of the brain, is prevented to some extent by the
respiratory movements. So long as the respiration is natural
and quiet, the movements of the chest hasten and assist the
venous circulation; but in forced or laborious respiration they
do not assist, and may even retard its flow. This explains why,
up to a certain stage of cholera, there is not much venous con-
gestion of the brain, and the intellect remains clear; while
afterward when the respiratory efforts are much interrupted,
the congestion of the veins of the brain is excessive, and the
countenance becomes livid. So lopg as the respiratory move-
ments are uninterrupted, venous congestion of the brain is, to
some extent, prevented.

In all such cases the most excessive distension or congestion
of the veins will be within the abdominal cavity, particularly
in the veins which make up the portal vein and in the veins dis-
tributed through the liver. This is the condition of things in
cholera, and the congestion of the cava, and of the veins hav-
ing no valves emptying into it, is more excessive as collapse
approaches. The veins of the heart escape this excessive en-
gorgement of the great venous trunks, because, they have
valves. The heart, under the condition of things supposed,
could not work at all if its own internal circulation was inter-
fered with ; that is, the circulation of the coronary arteries and
coronary veins. The lungs also are beyond the range of con-
gestion or engorgement of the great venous trunks, because of
a valve at the mouth of the azygos veins. While the blood
continues to flow, the heart beats, though ever so feebly; and
although but a small quantity of blood passes through it, this
small quantity even is assisted on its way to the lungs by pass-
ing through an artery, the pulmonary, having within itself con-
tractile power. The mouth of the pulmonary artery is guarded
by valves, which prevent the regurgitation of blood from the
right side of the heart, though filled to excess. Wonderfully
wise provisions in the economy of Nature and greatly to be

156 Hyperemia and Congestion,

admired! But the venous azygos also has strong valves at its
mouth. The superior vena cava receives the vena azygos major
just before it enters the pericardium.

" The azygos veins connect together the superior and inferior
venae cavse, supplying the place of these vessels in that part of
the trunk in which they are deficient on account of their con-
nection with the heart. The larger — the right azygos vein —
commences opposite the first or second lumbar vertebra by re-
ceiving a branch from the right lumbar veins, sometimes by a
branch from the renal vein or from the inferior vena cava. It
enters the thorax through the aortic opening in the diaphragm,
and passes along the right of the vertebral column to the third
dorsal vertebra, where it arches forward over the root of the
right lung, and terminates in the superior vena cava just before
that vessel enters the pericardium. Whilst passing through the
aortic opening of the diaphragm it lies with the thoracic duct on
the right side of the aorta, and in the thorax it lies upon the
intercostal arteries, on the right side of the aorta and thoracic
duct, covered by the pleura.

'^Branches. — It receives nine or ten lower intercostal veins on
the right side, the vena azygos minor, several esophageal, medias-
tinal, and vertebral veins; near its termination, the right bron-
chial vein, and it is occasionally connected with the right superior
intercostal vein. A few^imperfect valves are found in this vein,
but its branches are provided with valves. The intercostal veins
on the left side, below the two or three upper intercostal spaces,
usually, from the trunks, named the left lower, and the left upper
azygos veins.

" The left lower or small azygos vein commences in the lumbar
region by a branch from one of the lumbar veins or from the left
renal. It passes into the thorax through the left crus of the dia-
phragm, and, ascending on the left side of the spine as high as
the sixth or seventh vertebra, passes across the column behind
^the aorta and thoracic duct to terminate in the right azygos vein.
It receives the four or five lower intercostal veins of the left side
and some esophageal and mediastinal veins.

Hyperemia and Congestion, 157

^^The left upper azygos vem varies according to the size of the
left superior intercostal. It receives veins from the intercostal
spaces between the left superior intercostal vein and highest
branch of the left lower azygos. They are usually two or three
in number, and join to form a trunk which ends in the right
azygos vein or in the left lower azygos. When this vein is
small, or altogether wanting, the left superior intercostal vein
will extend as low as the fifth or sixth intercostal space.

^'The bronchial veins return the blood from the substance of
the lungs; that of the right side opens into the vena azygos
major, near its termination; that of the left side in the left supe-
rior intercostal vein." (Anatomy, Descriptive and Surgical, by
Henry Gray, F. R. S.)'

I have said, in a former chapter, that although the finding
of valves in the veins by Fabricius was considered to be a very
important discovery, no importance had been attached to the
uses of those valves by writers on practical medicine. Their
uses seem to have been ignored from the time of Fabricius to
that of John Estin Cook. Since his day they have been barely
alluded to by writers on the practice of medicine. A knowledge
of the anatomy of the azygos vein is necessary to understand
the uses of valves in the veins and Dr. Cook's theory of conges-
tion. Hence the extract above from Gray's Anatomy.

Teachers and writers on the practice of medicine are too much
engaged in the study of microscopic appearances (histology) to
attach any importance to such a quantity as valves in the veins,
and valves at the mouth of the azygos veins in particular'.

It will be seen from the above description of the azygos vein
and its branches, that the veins coming from the spinal column,
and the parts embraced under that general term, as well as the
veins coming from the muscles engaged in the respiratory move-
ment, and from the lungs themselves, having valves in them, these
parts can not be directly affected by excessive congestion of the
vena cava and its branches, because the blood can not regurgi-
tate back into the vena azygos. The respiratory movements on
which life depends as much as upon the action of the heart itself,

158 Hyperemia and Congestion.

are thus protected from a disturbing cause in the animal econ-
omy, which itself threatens death.

Venous congestion of the spinal column is also thus prevented
to a great extent.

Thus we see clearly and distinctly that the part of the venous
system which is particularly the seat of excessive congestion, is
the vena cava and its branches, which have no valves in them.
We have also noticed that venous congestion of the brain is,
to some extent, limited by the respiratory movements ; so that,
except the main trunks of the vense cavaB, it is the numerous
branches found within the abdominal and pelvic cavities which
are the receptacles of this excessive amount of blood.

I have taken cholera as the type to express a form of disease,
one of the most remarkable features of which is excessive
abdominal venous congestion. The body is wasting rapidly.
The aqueous portion of the blood is being poured out from the
arteries distributed to all of the abdominal organs in the form of
copious rice-water discharges. (I have yet to speak of the capil-
lary system in this connection, but must now pass by it.)

By this loss of its watery parts the blood becomes thickened,
and its motion through the abdominal veins is more sluggish and
retarded. The blood may be said to have become, in part, effete.
Destructive metamorphosis is rapidly going on, and effete matter
proper is continually passing from the capillary system into the
venous trunks. But a limited quantity passes through the lungs
in the stage of cholera now referred to ; so that the blood is not
revivined as usual in its passage through those organs. Animal
heat is growing rapidly less, the breath being colder than the
external air. The spleen ceases to rejuvenate the blood passing
through it, being itself the seat of excessive congestion.

(I have yet to notice the condition of the nervous system.)

As has been so repeatedly stated, all the blood in the abdom-
inal organs is carried by the veins to the liver. It has no other
way to get back to the heart. The reader must see at a glance
what kind of blood the liver has to act upon in a cholera patient.
The quantity is excessive, the quality is vitiated in every manner

Hyperemia and Congestion. 159

in which it can be, both by subtraction and addition; and the
motion of this blood through the liver is unusually slow and
sluggish. All of this is coincident with and depending upon
weakened action of the heart. The work thrown upon the liver
is so overwhelming, and the blood upon which it has to work
is so deteriorated that it stops action altogether, and no longer
works at all.

From the first appearance of rice-water discharges the liver
ceases to separate bile from the blood. Unless this function
of the liver is restored by some means death by cholera is inev-
itable. No man ever yet saw a case of cholera begin to improve
or to recover until the liver had recommenced the separation of
bile from the blood and poured it into the intestines, as evidenced
by the stools. To relieve this state of things, calomel is the all-
efficient remedy. It will, given in sufficient doses, just as cer-
tainly make the liver separate bile from the blood in all curable
cases as two and two make four. But I have not yet come to
the treatment of cholera. Dr. Cook explains in detail how the
venous congestion is observed in various forms of disease. I am
not writing a treatise on the practice of medicine, but am only
endeavoring to explain certain physiological and pathological
facts, and the uses of particular medicines which grow out of a
correct understanding of those facts.

I have said that in the collapse of cholera we have the fullest
expression of venous congestion. In all other forms of disease
it is approximative in degree. In all forms of malarious, mias-
matic, or autumnal fevers it exists in certain stages. In the cold
stage of intermittent or ague and fever, and particularly in what
is known as congestive fever in the South, the internal venous
congestion is almost as complete as it is in cholera. In this stage
of these fevers the action of the heart is excessively weakened,
and the congestion of the vena cava and its branches is great ;
but fortunately in intermittent fevers, and also in congestive
fevers, which do not terminate fatally, in one of its cold stages,
after a shorter or longer interval, the heart recovers its lost
power, and the circulation is again fully established, the blood

160 Hyperemia and Congestion.

being freely distributed through both arteries and veins. We
have, indeed, increased motion in the current of the circulation,
which we call fever, attended with an excess of animal heat.
This fever is followed by perspiration or sweating, which is
sometimes excessive. During this sweating stage the action
of the heart again becomes weak, causing a corresponding con-
gestion of the venous cavity, but to a less extent than in the
cold stage.

Miasmatic fevers of an intermittent type are frequently of
long - continued duration, and the constant recurrence of con-
gestion in the abdominal organs causes it sometimes to become
permanent, and we have enlarged spleen, with a fullness of the
portal veins generally, and of those of the liver in particular.
Here, again, we have all -important work for the liver to per-
form. Miasmatic fevers go under the general head of bilious
fevers. I know that there is no class of diseases in which qui-
nine is so efficacious in its curative effects as in fevers produced
by miasm or malaria ; but I also know that there is no class of
fevers in which the judicious use of emetics and cathartics is
more serviceable. The liver must be continually aroused to
action to remove this constantly returning congestion. This
it does by separating effete matter from the blood and convert-
ing it into bile. Fevers of this class have existed from time im-
memorial, and physicians have always and every where observed
that the secretion or excretion of bile is always suspended daring
their continuance unless some means are employed to remove the
difficulty. Where quinine or other anti-periodics alone are relied
upon, the cure is incomplete, and the individual is generally left
in a condition of chronic ill health.

Neuralgia and other forms of nervous complaint, with indi-
gestion or some form of dyspepsia, are far more frequent now
than they were formerly, when more attention was paid to the
secretions of the liver in the treatment of these forms of fever.
Congestion of the venous system within the cavities, as explained
by Dr. Cook, is also of frequent occurrence in many forms of
chronic disease.

Hyperemia and Congestion. 161

The judicious use of medicines which cause the liver to sep-
arate bile from the blood is more certainly curative than any-
other method of cure in the treatment of this class of affections.
Two things are accomplished by this method of cure : first, effete
matter, which is constantly increasing under this state of things,
is removed from the blood; second, the heart's action and the
circulation of the blood are made to become regular and health-
ful. It will be noticed, as stated by Dr. Cook, that the renal
veins empty into the vena cava, and therefore become congested
when that great vein and its branches contain an unusual amount
of blood. The renal veins have no valves. This congestion of
the renal veins incapacitates the kidneys for the healthful per-
formance of their functions. When an individual is suffering
from any form of miasmatic fever the urinary secretions are
always irregular in quantity. The kidneys, acting alone upon
arterial blood, exert no influence whatever upon the large quan-
tity of blood congested in the vena cava and its branches. To
talk about their removing effete matter from the blood, which
exists principally in this accumulated congested blood within the
abdominal veins, is absurd. Healthy urine will be secreted or
excreted in these cases when the liver secretes bile freely, and
not until then. A proper cathartic is the best diuretic in all such
cases.

I could instance many other forms of disease, where these
congestions depending upon weakened action of the heart are of
constant occurrence, but I must pass on. There are other dis-
turbances growing out of these congestions which I might also
notice, but I must defer their consideration. The congestion of
the venous cavity^ as explained by Dr. Cook, is not a chimera, it
is not a supposition, it is not a theory as that word is commonly
understood ; but it is what must take place when the action of
the heart becomes weakened, and when a full, healthy, and regu-
lar current of blood does not pass through that organ. In the
maladies immediately referred to above there is either an en-
tire loss of appetite, or it is depraved, and digestion, in the full
meaning of that word, is irregular and imperfect. Destructive

11

162 Hyperemia and Congestion.

metamorphosis, or waste, is the consequence of this imperfect
digestion and of the morbific influence constituting the disease.
Effete matter is separated from the solid organism in large quan-
tities, and entering first the venous system it is contained chiefly
in the vessels of the congestive venous cavity. If the liver is
made to act, this effete matter is separated from the blood by the
liver and is poured out in the form of excrementitious matter,
called bile. Bat if the liver does not act, as is too often the
case in the maladies already referred to, this congested blood, con-
taining effete matter, passes slowly through the liver and is car-
ried on through the vena cava, ascending to the heart. It is then
mixed up with the arterial blood, and the whole animal economy,
particularly the venous system, suffers in consequence. It does
not require a microscope to see these things. They are facts
which can not be explained away. The difficulty can not be
removed except by secretion, call it excretion if you please, and
the liver is the secernent organ by which this morbific effete
matter is secreted from the blood and thrown off from the body.
The kidneys, as above remarked, not acting upon the venous
blood, have little or nothing to do with the removal of effete
matter from it. If the liver is unable to act, and effete matter
passes into general circulation, then, possibly, the kidneys may
remove some of it from the blood, as they remove foreign or
medicinal substances which are sometimes swallowed; but they
accomplish almost nothing in the removal of venous congestion.
I have once said that the older medical writers supposed that
the lymphatics were the absorbents proper, and that they re-
moved effete matter from the solid organism. Besides what I
have already said in regard to the lymphatic system, I would call
the reader's attention to the fact that the lymph is not carried
directly to the secernent organs, as the liver, kidneys, or skin;
but, in health, is first mixed with the food coming from all
sources before it reaches the right side of the heart, and in all
cases is poured into the cava near the right auricle. In my
opinion, the capillary system presides over, and controls, absorp-
tion. It is the system through which both destructive and

Hyperemia and Congestion. 163

constructive metamorphosis is effected. I will consider this sys-
tem briefly, as it is connected with hyperemia and congestion.

I copy from Dr. Dalton's Physiology sufficient to make intel-
ligible the few remarks I have to make on the capillary system :

"The capillary blood-vessels are minute inosculating tubes
which permeate the vascular organs in every direction and bring
the blood into intimate contact with the substance of the tissues.
They are continuous with the terminal ramifications of the arte-
ries on the one hand, and with the commencing rootlets of the
veins on the other. They vary somewhat in size in different
organs and in different species of animals ; their average diam-
eter in the human subject being a little over ^-^^^ of an inch.
They are composed of single, transparent, homogeneous, some-
what elastic, tubular membrane, which is provided at various
intervals with flattened, oval nuclei. As the smaller arteries
approach the capillaries, they diminish constantly in size by suc-
cessive subdivision, and lose first their external or fibrous tunic.
They are then composed only of the internal or homogeneous
coat, and the middle or muscular. The middle coat then dimin-
ishes in thickness, until it is reduced to a single layer of circular,
fusiform, unstriped, muscular fibers, which in their turn disap-
pear altogether as the artery merges at last in the capillaries,
leaving only, as we have mentioned, a simple homogeneous,
nucleated, tubular membrane, which is continuous with the
internal arterial tunic.

"The capillaries are further distinguished from both arteries
and veins by their frequent inosculation. The arteries con-
stantly divide and subdivide as they pass from within outward,
whilst the veins as constantly unite with each other to form
larger and less numerous branches and trunks as they pass from
the circumference toward the center. But the capillaries simply
inosculate with each other in every direction in such a manner
as to form an interlacing network or plexus, the capillary plexus,
which is exceedingly rich and abundant in some organs, less so
in others. The spaces included between the meshes of the capil-
lary network vary also in shape as well as in size in different

164 Hyperemia and Congestion.

parts of the body. In the muscular tissue they form long par-
allelograms; in the areolar tissue, irregular, shapeless figures,
corresponding with the direction of th#fibrous bundles of which
the tissue is composed. In the mucous membrane of the large
intestine the capillaries include hexagonal or nearly circular
spaces, inclosing the orifices of the follicles. In the papillae
placenta they are arranged in long spiral loops, and in the adi-
pose tissue in wide meshes, among which the fat vesicles are
entangled.

" The motion of the blood in the capillaries may be studied by
examining under the microscope any transparent tissue of a suffi-
cient degree of vascularity. One of the most convenient parts
for this purpose is the web of the frog's foot. When properly
prepared and kept moistened by the occasional addition of water
to the integument, the circulation will go on in its vessels for an
indefinite length of time. The blood can be seen entering the
field by the smaller arteries, shooting through them with great
rapidity and in successive impulses, and flowing off again by the
veins at a somewhat slow rate. In the capillaries themselves the
circulation is considerably less rapid than in either the arteries
or the veins. It is also perfectly steady and uninterrupted in
its flow. The blood passes along in a uniform and continuous
current, without any apparent contraction or dilatation of the
vessels, very much as if it were flowing through glass tubes.
Another very remarkable peculiarity of the capillary circulation
is, that it has no definite direction. The numerous streams of
which it is composed do not tend to the right or to the left, nor
toward any one particular point. On the contrary, they pass
above and below each other, at right angles to each other's
course, or even in opposite directions, so that the blood, while
in the capillaries, merely circulates promiscuously among the
tissues in such a manner as to come immediately in contact with
every part of their substance.

" The motion of the white and red globules in the circulating
blood is also peculiar, and shows very distinctly the difference in
their consistency and other physical properties. In the larger

Hyperemia and Congestion, 165

vessels the red globules are carried along in a dense column in
the central part of the stream; while near the edges of the vessel
there is a transparent space occupied only by the clear plasma
of the blood, in which no red globules are to be seen. In the
smaller vessels the globules pass along in a narrow column, two
by two, or following each other in single file. The flexibility and
semi-fluid consistency of these globules are here very apparent,
from the readiness with which they become folded up, bent, or
twisted in turning corners, and the ease w^ith which they glide
through minute branches of communication, smaller in diameter
than themselves. The white globules, on the other hand, flow
more slowly and with greater difiiculty through the vessels.
They drag along the external portions of the current, and are
sometimes momentarily arrested, apparently adhering for a few
seconds to the internal surface of the vessel. Whenever the cur-
rent is obstructed or retarded in any manner, the white globules
accumulate in the affected portion, and become more numerous
there in proportion to the red.

*^ It is during the capillary circulation that the blood serves
for the nutrition of the vascular organs. Its fluid portions
slowly transude through the walls of the vessel and are absorbed
by the tissues in such proportion as is requisite for their nour-
ishment. The saline substances enter at once into the composi-
tion of the surrounding parts, generally without undergoing any
change. The phosphate of lime, for example, is taken up in
large quantity by the bones and cartilages, and in smaller quan-
tity by the softer parts, while the chloride of sodium and potas-
sium, the carbonates, sulphates, etc., are appropriated in the
special proportions by the different tissues, according to the
quantity necessary for their organization. The albuminose in-
gredients of the blood, on the other hand, are not only absorbed
in a similar manner by the animal tissues, but at the same time
are transformed by catalysis and converted into new materials
characteristic of the different tissues. In this way are produced
the musculin of the muscles, the ostien of the bones, the carti-
lagin of the cartilages, etc. It is probable that this transfor-

166 Hyperemia and Congestion,

mation does not take place in the interior of the vessels them-
selves, but that the organic ingredients of the blood are absorbed
by the tissues, and at the same moment converted into new mate-
rials by contact with their substance. The blood, in this way,
furnishes directly or indirectly all the materials necessary for the
nutrition of the body/' (Dalton's Physiology, pages 295 to 298,
inclusive.)

Rapidity of the Circulation. — "The rapidity with which the
blood passes through the entire round of the eirculation is a
point of great interest, and one which has received a considerable
share of attention. The results of such experiments as have been
tried show that this rapidity is much greater than would have
been anticipated. Herring, Poissenille, and Matlencci have all
experimented on this subject in the following manner: A solu-
tion of ferrocyanide of potassium was injected into the right
jugular vein of a horse at the same time that a ligature was
placed upon the corresponding vein on the left side and an open-
ing made in it above the ligature. The blood flowing from
the left jugular vein was then received in separate vessels, w^hich
were changed every five seconds, and the contents afterward
examined. It was thus found that the blood drawn from the
first to the twentieth second contained no traces of ferrocyanide,
but that which escaped from the vein at the end of from twenty
to twenty -five seconds showed unmistakable evidence of the
presence of the foreign salt. The ferrocyanide of potassium
must therefore during this time, have passed from the point of
injection to the right side of the heart, thence to the lungs and
to the pulmonary circulation, returned to the heart, passed out
again through the arteries to the capillary system of the head
and neck, and thence have commenced its returning passage to
the right side of the heart through the jugular v^in."

" By extending these investigations to different animals, it
was found that the duration of the circulatory movement varied,
to some extent, with the size and species. In the larger quadru-
peds, as a general rule, it was longer; in the smaller, the time
required was less." (Page 302.)

Hyperemia and Congestion, 167

The round of the circulation through the arterial, capillary,
and venous systems being accomplished in so few seconds, how
almost inappreciable must be the time required for the arterial
blood to flow from the left ventricle of the heart to the face ;
and yet there are distinguished physiologists who endeavor to
explain in some other manner than the heart's action, the health-
ful blush or hyperemia on a maiden's cheek.

This leads us to consider the connection of the nervous sys-
tem with the circulation of the blood, and particularly its con-
nection with the capillary circulation. Since the great discovery,
by Sir Charles Bell and Magendie, of the division of the nerves
into "motor" and "sensitive,'' arising by separate roots from
distinct portions of the spinal column, the next great discovery
is that made by M. Claude Bernard as to the "vasomotor"
nerves, or rather the nerves which control the contractility or
dilatability of the arteries. Dr. Brown-Sequard and Dr. Agus-
tus Waller have also confirmed the truth of the discovery by M.
Bernard. Together with him these gentlemen have added much
to our knowledge of the nervous system. I have not seen the
works or essays of either of these gentlemen, except a course of
lectures delivered by Dr. Brown-Sequard and published in a
book at Philadelphia in 1860.

The sum of this discovery is thus condensed in Dalton's
Physiology : " Another very striking fact concerning the sympa-
thetic, relates to the changes produced by its division in the
nutritive processes of the parts supplied by it. One of the most
important and remarkable of these changes is an elevation of
temperature in the affected parts. If the sympathetic nerve be
divided on one side of the neck in the rabbit, cat, or dog, an
elevation of temperature begins to be perceptible on the corre-
sponding side of the head in a very short time. In the cat we
have found a very sensible difference in the temperature between
the two sides, at the end of ten minutes; and in the rabbit at
the end of half an hour. A muscular congestion of the parts
also takes place, which may be seen to great advantage in the ear
of the rabbit when held up between the eye and the light. The

168 Hyperemia and Congestion,

elevation of temperature in these cases is very perceptible to the
touch, and may also be measured by the thermometer. Bernard
has found it to reach 80° or 90° F. The elevation of temper-
ature and congested state of the parts are sometimes found to be
diminished by the next day, and afterward disappear rapidly.'^

Sometimes they continue much longer. Galvanization arrests
the increased flow of blood into the parts which were under the
control of the divided nerve.

Dr. Brown-Sequard says, in his book, page 142 :

Section of the Nerve. Galvanization of the Nerve.

1. Dilatation of blood-vessels. 1. Constriction of blood-vessels.

2. Afflux of blood. 2. Diminution of blood.

3. Increase of vital properties. 3. Decrease of vital properties.

Dr. John Chapman, of London, who, in his essays, adopts the
views of Claude Bernard and Dr. Agustus Waller, thus presents
the case:

"Now I have proved by numerous experiments that cold
applied to the back not only exerts a sedative influence (a ^depol-
arizing' influence, according to Dr. Tood) on the spinal cord, but
also on those nervous centers which preside over the blood-
vessels in all parts of the body. The modus operandi of this
influence on those centers and its effects may be thus stated: 1.
It partially paralyzes them ; 2. By means of the partial paralysis
thus affected it lessens the nervous currents in the vasomotor
nerves emerging from the ganglia or nerve-centers acted upon,
and stimulating the muscular fibers surrounding the arteries
influenced; 3. By thus lessening those currents, it lessens the
contractile energy of muscular bands of the arteries to which
those currents flow, and by doing so facilitates the dilatation of
the arteries themselves; 4. By thus inducing the condition of
easy dilatability in the arteries acted upon, it enables the blood,
which flows in the direction of least resistance, to enter them in
great volume and with greater rapidity than before."

" The conditions here enumerated are analogous to those first
induced in 1851 by Prof Claude Bernard, when he divided the
cervical sympathetic nerve."

Hyperemia and Congestion, 169

"Of course, the physiological conditions induced by heat
applied to the back are precisely opposite to those already enu-
merated as induced by cold: 1. The temperature of the sympa-
thetic ganglia being raised, the flow of blood to them becomes
more copious, and consequently their functions become more
energetic than before; 2. Their nervous influence passes in fuller
and more powerful streams along the nerves emerging from
them and ramifying over the blood-vessels which they control ;
3. The muscular bands surrounding the vessels are stimulated
by this increased nervous afflux to contract with more than their
usual force and so to diminish proportionately the diameter of
the vessels themselves; 4. The diameter of the vessels being
thus lessened, the blood flows through them in less volume and
with less rapidity than before ; indeed, it is probable that while
the nervous ganglia in. question are made to emit their maximum
of energy many of the terminal branches of the blood-vessels
acted upon become completely closed/'

" This series of effects caused by heat applied to the back is
identical with that induced in the head by galvanizing the cerv-
ical sympathetic/' (Essay on Sea-sicknessJ

Dr. Chapman has based a new system of practice upon the
principles above expressed, to which I shall have occasion to
refer in another chapter. The above extracts are intended to
show clearly and fully what is understood to be the discovery
of Claude Bernard and others. I hope that the reader under-
stands it. I regret to differ from so distinguished authorities.
Let us examine carefully what it is they teach. It seems to be
agreed that the vasomotor nerves preside over and control the
vibratory movements of the arteries. As to whether the vaso-
motor nerves belong to the ganglionic or sympathetic nervous
system or originate in the upper part of the spinal column and
medulla oblongata, and only pass through the ganglions of the
sympathetic system proper, to be bound up in the same sheath
with nerves originating in the ganglions, does not appear to me
to be fully determined. There is certainly a discrepancy and an
apparent contradiction.

170 Hyperemia and Congestion,

As my views on this subject are so entirely different from
the authors to whom I have referred, it is not important that I
should notice these seeming discrepancies. We are told that the
division of the cervical sympathetic nerve, by destroying the
nerve-current which causes the arteries to contract, allows them
to dilate more freelv, which is followed by an increased flow of
blood. On the other hand, by galvanizing the divided nerve,
thus supplying the place of the lost nerve-current, the arteries
are made to contract, and thus to carry less blood.

Dr. Chapman teaches that ice applied to the spinal column,
and over the ganglia of the sympathetic nerves, benumbs or
paralyzes the nervous centers, producing an effect approximative
to a division of the nerves; and that heat, on the other hand, by
stimulating the nervous centers, produces an effect analogous to
galvanization.

A theatrical manager once announced the play of Hamlet
with the character of Hamlet left out. So would it be to-day
with many distinguished physiologists as to the part the heart
performs in the circulation of the blood. It seems to me that
they would be glad if the heart was left out of consideration. It
would be so much more scientific to account for the circulation
of the blood, particularly in the capillary system, by microscop-
ical and chemical explanations.

It would make my book too large to notice fully this and
many other kindred subjects. "We are told nothing as to the
effect of the division of an important nerve upon the action of
the heart, whether it increases or lessens its force; nor are we
told any thing as to the effect upon the heart's action of galvan-
ization. If the facts were observed, they were considered of too
little importance to be recorded in the books.

The power of an artery to dilate or contract is an inseparable
and coexistent power. In other words, the contractibility and
dilatability of an artery are coexistent functions, as much so as
the systole and diastole of the heart itself. Annul or destroy one
of them, and the other ceases instantly, and forever. Benumb
or paralyze to a limited extent the power to contract or the power

Hyperemia and Congestion, 171

to dilate, and the other is equally affected. Destroy one, and
you destroy both, and in that qase the arteries would exert no
more influence upon a torrent of blood floating through them,
than does a leather hose-pipe upon the water floating through it
from a fire-engine. No physiologist will deny the fact that the
arteries carry more blood to a gland engaged in active secretion
than when the gland is not secreting. Tlie arteries are then
being more dilated, and yet the nervous system in all its parts
is intact.

During health all glands secrete more freely and copiously ;
and during health the vasomotor nerves exert the greatest influ-
ence upon the coats of the arteries, and upon secretion generally.
During the orgasm of erectile organs the whole nervous system
is exerting its maximum influence, and yet the arteries dilate to
receive the unusual quantity of blood. The division of the nerve
in the necks of animals produced a lesion, d/s-ease in the parts
which had been supplied by the divided nerve. The cZis-ease or
lesion in the parts afl*ected become a focus of irritation, and upon
the old maxim of ubl irritatio ibi affiuxus, blood flowed more
freely to it, as to a part which is inflamed. If all the nerves
going to the parts in which are observed increased heat, and
increased vascularity, had been, or could be, divided, then the
arteries passing through those parts would be as so many leather
tubes, having neither the power to dilate nor to contract. But
all the nerves are not divided, nor could they be divided. The
sympathetic and vasomotor nerves are intimately mixed up with
and bound up together with all the other nerves; so that the
arteries still have the power to dilate and to contract to a more
limited extent than if a nerve had not been divided.

But it is said that galvanization causes the arteries to contract,
and thereby lessens the quantity of blood which flows through
them. I would say that galvanization interrupts the vital func-
tions of the parts under consideration, and the more particularly
so because they are already in an unnatural condition. That the
arteries assist the heart in carrying the blood to distant parts of
the body, and in returning it through the capillary and venous

172 Hyperemia and Congestion.

systems back again to the heart, I believe that all physiologists
agree.

This force or power in the arteries is evidenced by their vibra-
tory movements, causing what we call the pulse or pulsations.
It is the coexistent power of the arteries to contract and dilate.
When it is exerted to its maximum we have hyperemia of those
vessels; venous congestion, on the other hand, depending upon
weakened action of the heart. That this vibratory power of the
arteries — that is, the power to contract and to dilate — depends on
the vasomotor nerves, I have no doubt, and I will explain it by
my theory.

I only ask physiologists to give the facts which I will present
a full and candid consideration. I ask them, also, not to allow
their minds to be over-influenced by authorities.

In the Eclectic Journal of Medicine, published by John Bell,
M.D., Philadelphia, vol. 3, page 375, for the year 1839, will be
found the following :

"dr. darby's case of hemiplegia.

^'Lexington, Ky., May 10, 1839.
"Dr. John Bell:

" Sir — Being a subscriber to your journal, I send you a case for pub-
lication if you think it worth a place. Mr. B,. aged about fifty years,
during the course of a severe pneumonia, from which he was recover-
ing, upon the occasion of a violent mental excitement was struck with
a palsy of one side including the tongue. Mr. B. had felt for many
years a numbness in the right arm; had been injured on the frontal
bone during youth, from which, however, he soon recovered, and
never experienced afterward any inconvenience. Was of a robust
make, sanguineous temperament, rendered more excitable by free liv-
ing. He died in ten days, in spite of the efforts of Dr. J. M. Bush and
myself. No examination of the body was allowed, yet the case may
be worthy of note for the following reasons : The right side was de-
prived of muscular power. On this side there was a strong, full
pulse, while on the side not enervated there was no pulse at all.
There was no difference of temperature on the two sides. The pa-
tient could not speak, but was entirely rational to his death. In
reference to the pulse I will further add, that while I could scarcely
feel it on the left side, it was so strong and full on the right side as to

Hyperemia and Congestion, 173

authorize me to bleed him copiously about the second day of the
palsy, and as I thought, with benefit."

'*[As no post-mortem examination was made, any speculation on
the cause of the phenomena in this case would be of little value.
We omit those ofiered by Dr. Darby. — Editor Select Medical

LrBRARY.]"

The speculations which Dr. Bell declined to publish, because
no post-mortem examination had been made, were given to Dr.
Bush at the time. He was then Professor of Anatomy in Tran-
sylvania University. The same explanations have been given to
many physicians and other persons in conversations on this
subject.

Since the discovery of Sir Charles Bell, all physiologists, I
believe, agree that hemiplegia, or paralysis of one side of the
body, depends upon a lesion of the brain or medulla oblongata
on the opposite side. The thing to be explained is the strong,
full pulse on the paralyzed side, while there was at first no pulse
to be felt on the left side in the radial artery, and afterward a
very feeble one. The case reported in BelPs Journal was treated
in the latter part of April or first of May, 1838. Since then I
have treated many cases of paralysis more or less complete ; hav-
ing treated from the beginning of autumn in one year to the end
of spring in another as many as nine cases. In every one of
these I observed that the pulse was stronger and fuller on the
paralyzed side than on the well side. In May, 1870, 1 was called
to see a gentleman over eighty years of age. He had been sud-
denly attacked while sitting up in a chair to be shaved, but had
been placed back in bed. On account of a fractured or dislo-
cated hip-joint, and other broken bones, he had to be taken out
of bed by several persons, and put back again in the same way.
It being difficult to make out a diagnosis, for I could not tell
whether he could move his limbs or not, on account of his
old injuries, I was at a loss how to make out the case until
I felt the pulse in both wrists. I immediately observed that
it was much stronger on one side than it was on the other,
and pronounced it a lesion of the brain and spinal column.

174 Hyperemia and Congestion,

The paralysis afterward became evident, and the patient died on
the eighth day.

I have called the attention of many physicians at the bed-
side to this difference of the pulse on the right and left sides,
but have never seen it noticed in a book. My explanation of
the phenomenon is this: The sympathetic system is a distinct
one from that of the sensitive and motor nerves. It presides
over the functions of organic life, and, as such, controls the
vibratory movements of the arteries. By means of the nervous
currents from the ganglions of this system, the arteries are
enabled to contract and to dilate, and thus assist the heart in
carrying on the circulation of the blood. The ganglions of the
sympathetic system stand in the same relation to the functions of
organic life that the brain, medulla oblongata, and spinal column
stand in relation to the nerves of the special senses and to the
nerves of sensation and motion. The ganglions of the sympa-
thetic system being the centers of that system, do not originate in
the brain, medulla oblongata, or spinal column, but send branches
to those several centers of animal life, which branches have their
roots or origin in the ganglions of the sympathetic system. The
system of animal life and of organic life are so intimately con-
nected together by these branches that a lesion of the brain,
medulla oblongata, or spinal column, on one side of the body,
involves and carries with it a lesion or paralysis of the system
of organic life on the same side.

Hence it results, as in the case reported in BelPs Journal, that
a lesion of the spinal column on the left side, causes them to
lose the power to contract and to dilate. The arteries, having
lost this power, become approximatively, according to the sever-
ity or extent of the lesion, like so many leather tubes, and conse-
quently they are unable to receive and carry on the usual current
of the circulation. Hence we have a smaller and weaker pulse
on the well side of the paralyzed man ; but it can only be called
the well side so far as motion and sensation, functions of the
animal life, are concerned. It is really the paralyzed side, so
far as the functions of organic life are concerned. But there

Hyperemia and Congesticn. 175

being no lesion in the brain, medulla oblongata, or spinal col-
umn on the right side of the case reported, as in all other simi-
lar cases, the ganglions, or nervous centers of the sympathetic
system remain, in a natural and healthy condition, arteries which
are controlled by nerves coming from them retain their full
power to contract and dilate, and thus carry on freely the circu-
lation of the blood.

This is the explanation which I gave to Dr. James M. Bush
at the time, and which'would have been known to the Avorld as
early as 1839 if Dr. Bell had not declined to publish it. My
then convictions have since been confirmed. In the nervous
system of animal life there are nerves of motion and sensation,
besides the nerves of special functions. In the nervous system
of organic life I believe there are also two distinct sets of nerves
— one which presides over the organic movements of the blood-
vessels, now called the vasomotor nerves; and the other which
presides over the secretions. Both of these sets of nerves take
their roots, as I think, in the ganglions of the sympathetic sys-
tem. It will be observed in the case reported that the action of
the heart continued to be vigorous so as to justify, as I thought,
blood-letting. The heart is an organ of animal life, and while
it depends in part upon the nerves of organic life, it depends, to
a greater extent, upon other nerves for its vital force.

The arteries on the left side of the case reported in BelPs
Journal being paralyzed, and being approximatively like leather
tubes, were unable to receive the usual quantity of blood, and
hence there was a fuller and freer current of blood in the arteries
on the right side, which were in a healthy condition.

In 1874 I treated a case of paraplegia in company with my
friend Dr. James M. Bush, from June 18th to July 10th. On the
11th of July he left Lexington and returned to his home in Mich-
igan. The paraplegia was complete. The lesion of the spinal
column seemed to commence about the middle of the dorsal ver-
tebra. The action of the heart was free and the pulse was regu-
lar and full in both arms. The man perspired freely above the
line of paralysis. His intellect was clear and he was cheerful.

176 Hyperemia and Congestion.

He slept well. His appetite was good, and he digested his food
without inconvenience. Below the line of paralysis he was well
nigh a dead man. The discharge from his bladder and bowels
were entirely without his knowledge. He had no more control
over the motions of his limbs, and had no^ more sensation in
them than if they had been logs of wood. There is this quali-
fication to the last remark, under the influence of strychnine
he sometimes observed nervous twitchings in his lower limbs.
There was not the slightest perspiration below the line of par-
alysis. No pulsation in an artery could be felt any where below
that line. I felt every where where I thought it was possible to
feel one. Sloughing commenced early on the hips and limbs,
which we found it impossible to arrest.

Dr. Bush and I advised this man to return to his home in
Michigan, where he died in about a month afterward.

Now, according to the theory of M. Claude Bernard, there be-
ing an entire paralysis of the whole nervous system, both spinal
and sympathetic, below the line of lesion, the arteries were in a
state of the most complete dilatability, and there should have been
a full flow of blood to the very toes. According to my theory,
they had lost entirely and completely both the power to dilate
and to contract, and were, even the largest of them, like so many
leather tubes. That some blood flowed through them I do not
doubt, but this was forced through them entirely by the power
of the heart's action, this organ having remained, up to the time
we last saw him, in a healthy condition. The case referred to as
treated by Dr. Bush and myself in July of 1874 was the only
case of complete paraplegia I ever examined. I think it con-
firms, in the strongest possible manner, the truth of my theory,
viz. that the complete paralysis of the ganglionic or sympathetic
system of nerves arrests the vibratory movements in the arteries,
thus limiting the passage of blood through them, and also arrests
secretion. According to the theory of M. Bernard and his fol-
lowers, the passage of blood through the arteries of the lower
limbs in this case should have been freer and fuller; and I
should think that the perspiratory secretions ought not to have

Hyperemia and Congestion, 177

been arrested. If my theory is true his is exploded. The full-
ness of the pulse in one arm, and its feebleness in the other arm
of a paralyzed individual, depends upon the severity or complete-
ness of the paralysis— that is, of the lesion in the nervous sys-
tem ; at least this has been my observation. In these cases there
may be said to be hyperemia of blood on the one side, and anemia
of blood in the arteries of the other side, the hyperemia depend-
ing upon a vigorous condition of the heart's action, with full
contracting and dilating power in the arteries within which the
hyperemia exists; the anemia, on the other hand, depending upon
the fact that the arteries in which there is but little blood have
lost their power both to dilate and to contract, and are like unto
leather tubes. In the case of paraplegia the arrest both of the
circulation and of secretion caused the sloughing on the limbs
which we found it impossible to control. The sympathetic nerves
being completely paralyzed, the functions of organic life ceased.
I will have to recur again to the subject of hyperemia and con-
gestion and to the theory of M. Bernard when I present what I
have to say on cholera.

The opinions — the demonstrations, scientists would call them —
of Claude Bernard and his disciples may be satisfactory to micro-
scopic observers and to analytical philosophers, but they would
not be satisfactory to a Bichat or a Buckle; and perhaps mine
would not be any more so.

As electrical forces are known to be active in the torpedo,
or cramp-fish, I will give my views as to how they may influ-
ence the heart's action and the circulation of the blood in man.
They were published in the St. Louis Medical and Surgical Jour-
nal of July, 1879, from which they are copied. •

*'A NEW THEORY AS TO THE FORCES THAT DETERMINE THE CIRCULA-
TION OF THE BLOOD. BY. J. C. DARBY, M. D., OF MT. STERLING,
KENTUCKY.

"Olympian Springs, Ky., August 3, 1878.
**To Prof. Daniel Vaughan, M.D., Cincinnati, Ohio:

^^ Dear Sir — I have conceived a new theory as to the forces that
determine the circulation of the blood. I send it to you.

"Positive and negative electricity are two forces equally efficient.

12

178 Hyperemia and Congestion,

Bodies positively electrified repel each other, as do bodies negatively-
electrified; but bodies positively electrified attract those which are
negatively electrified, and vice versa. I assume that in the animal
body the left side of the heart and the arteries are positively electri-
fied, and that the right side of the heart and the veins are negatively
electrified. I assume also that the arterial blood is positively electri-
fied, and that the venous blood is negatively electrified.

''I assume also that the arterial blood is kept in a state of positive
electricity by its continual union with the oxygen of the atmosphere
as the blood passes through the lungs.

**As I have to begin at some one point in the round of circulation,
I start from the right side of the heart.

" The venous blood in the right ventricle being in a state of neg-
ative electricity, and the right ventricle itself being in the same
electrical condition, they mutually repel each other. The pulmonary
artery being positively electrified, attracts the blood in the right ven-
tricle, which is negatively electrified. This constant repulsion between
the venous blood and the walls of the right ventricle, and the attrac-
tion between the blood and the pulmonary artery, cause a continual
stream of blood into the lungs, and explain why an artery conveys
venous blood into the lungs. When this blood gets into the lungs, the
electrical condition is changed, and it becomes positively electrified by
its union with the oxygen of the atmosphere. It is then in an elec-
trical state, to be attracted by the pulmonary veins, which, like all
other veins, are negatively electrified. This explains why arterial
blood is conveyed to the left, side of the heart by veins, and not by
arteries. When this arterial blood, in a state of positive electricity,
enters into the left side of the heart, it finds that organ also in a state
of positive electricity. In perfect health both the arterial blood and
the left side of the heart are positively electrified to a high degree,
and the repulsion between them is sufficient to propel the blood to
every part of the body ; the arteries also being positively electrified,
continue this repulsion to their utmost extremities. As the blood
passes from the arteries into the capillary system it parts with its oxy-
gen and becomes negatively electrified, the reverse of what took place
in the lungs. The blood thus changed in its electrical condition is
forced into the veins, which are in the same electrical state that it,
the blood, is. This is the only point in my theory which is not
entirely satisfactory to me; but after the blood enters the veins the
propelling force is clearly apparent ; that is, the venous blood and the
veins being in the same electrical condition, repel each other, and thus
the blood is forced to the right side of the heart.

Hyperemia and Congestion, 179

''The activity and Lealthfulness of the circulation depend very
much upon the purity and quantity of the oxygen the blood receives
as it passes through the lungs. I believe that it is admitted that per-
fectly healthy atmospheric air contains a certain amount of ozone or
electrified oxygen. Atmospheric air which is not perfectly healthful
4)ntains a less amount of ozone. The regularity and healthfulness,
then, of the circulation depend upon the purity of the atmosphere.
Within an animal body, say man, I assume that the ganglia of the
sympathetic nervous system are so many batteries generating electri-
city—whether positive or negative, has yet to be determined; the
spinal column and the medulla oblongata are batteries also generating
either positive or negative electricity, I can not say which ; but I
assume that the sympathetic nerves or their ganglia generate one
kind of electricity, and the spinal column and the medulla oblongata
generate the other kind. What part the cerebellum plays in this
electrical apparatus has also yet to be determined. I do not suppose
that the brain proper or cerebrum generates either kind of electricity,
but that it receives positive and negative electrical currents, as does
the heart, the liver, or any other organ. If negative electricity is
generated by the ganglia of the sympathetic nerves, then that system
presides over the veins and the right side of the heart ; if the spinal
column and the medulla oblongata generate positive electricity, then
that system presides over the arteries and the left side of the heart.
Now, my object in sending this to you is to have you test the truth
of my theory by experiment.

"Your thorough knowledge of everything connected with elec-
trical forces and of all apparatus used in the generation of electricity
will enable you, I think, to construct delicate bodies and put them in
positive and negative electrical states, each one being separate. Then
apply one of these bodies positively electrified to an exposed artery,
and see if they will not repel each other ; and then apply the same to
an exposed vein, and see if they will not attract each other; and then
repeat the experiment with a body negatively electrified. I would
also want those delicately electrified bodies to be applied to a flow-
ing current of arterial blood, which is positive ; and to a flowing cur-
rent of venous blood, which is negative. I have not the knowledge of
electrical forces and of the apparatus used in their generation to deter-
mine these questions myself, and, if I had, my deficient eyesight
would not permit me to do it. I sincerely hope you may be willing
to make an effort to test the truth of my theory, and if you do, I
know you will soon determine whether it is the discovery of a great
physiological truth or merely the dreamings of my imagination. If

180 Hyperemia and Congestion,

you can get access to a slaughter-house you can readily make experi-
ments on exposed arteries and veins and also on flowing currents of
venous and arterial blood.

"Very truly your friend, ^j q Darby."

"Cincinnati, O., October 13, 1878. •
"To J. C. Darby, M.D., Mt. Sterling, Ky.i

*^ Dear Sir — Your letter of August 3d must have been delayed.
I have not been able to give it as much consideration as it deserves,
owing to ill health. In ascribing the circulation of the blood partly
or wholly to the influence of electricity, your doctrine is somewhat
analogous to one which I advanced in 1848 in regard to the movement
of the sap in trees. It has been ascertained that the sap ascends by
the wood of a tree to the leaves, and then descends by the bark and
the cambium, which lies between the bark and the wood. In a pam-
phlet entitled Vegetation Traced to Natural Causes, I have shown that
a circulation of galvanic currents in precisely the same course which
the sap takes would result from the action of air and water at the
roots and the action of light on the branches. To these galvanic cur-
rents I ascribe the movements and the elaboration of the sap, and
subsequently found that indications of electric action were found by
Becquerel, Bud, and others. The pamphlet alluded to was published
in 1848, and was received very favorably by Dr. Yandell in the West-
ern Journal of Medicine and Surgery for February, 1849.

"Although in a subsequent article I expressed some opinion of the
probable part which electricity may act in the circulation of the blood,
I did not pursue my inquiry far in that direction.

"Dr. J. W. Draper, however, about the same time expressed the
same opinion, that the action of the heart is not capable of drawing
the blood through the capillaries. The part which electricity plays in
the human organization was soon afterward brought more prominently
before the public by Alfred Smee, in his lectures on Electro-Biology,
or the Voltaic Mechanism of Man"; his researches were mainly
experimental, and they were afterward controverted by his oppo-
nents on the* grounds that the living rabbits which he employed had
their vital functions deranged by mutilation, and by the insertion of
his needles for testing the galvanic currents, and it was accordingly
contended that his results could not be considered normal.

" I have never seen Smee's reply to his critics, nor am I aware that
he made any; but since his death his views do not seem to have
received much attention. His doctrines were first announced in a

Hyperemia and Congestion, 181

lecture before the Royal Institute, and I think they have been pub-
lished in the London Lancet for 1850, etc.

"In bringing your doctrines before the medical profession, it will
be weU to consider that the idea of the action of the heart is so deeply
rooted in the scientific minds that it can not be easily eradicated. It
may, on that account, be necessary to regard electricity as playing
only a subordinate part, unless it can be shown that it produces the
rhythmical movements of the heart. In taking the last view, there are
some difficulties which it is not easy to remove. It is also necessary
to consider that in experiments with statical or frictional electricity,
very perfect insulation is necessary, and this does not exist in the
organs of the human body. It was such considerations that induced
me to regard the electricity concerned in vegetation as of a voltaic or
dynamic character, and not analogous to that of the Leyden jar, or the
electrical machines. Your theory might, perhaps, admit of a similar
modification. No insulation is necessary for the successful operation
of a galvanic battery. I would like much to be able to aid you as
much as possible by making experiments to support your doctrine,
but in my present feeble health it would be impossible for me to do
any thing at the slaughter-house of this city. Besides this, it requires
the most delicate and expensive electrical apparatus to detect the
very feeble electric currents circulating along the tissues of plants or
any part of the animal body. The idea of the analogy of the human
frame and a galvanic battery is said to have originated with Napoleon
Bonaparte, about the beginning of this century, on seeing one of the
first batteries exhibited before Academic des Sciences at Paris. He
pronounced it a resemblance of life.

" Your sincere friend, ,, ^^^^ Vaughan."

I have distinctly said, in the first chapter of this book, that
dynamic forces are under the control of the laws of vitality.
The theory above given is to be considered with this limitation.
My distinguished friend Dr. Vaughan was correcting the proof-
sheet of a scientific article on his death-bed, which article I sup-
pose was published shortly after his decease. His letter in reply
to mine is probably the last of his writings that' have been pub-
lished.

182 The Renewal of Life.

CHAPTER X.

The Eenewal of Life.

We now come to consider briefly the disturbances which affect
these several systems of animal life.

I can not better or more fully express the views entertained
by scientific physicians, both in this country and Europe,
when man is considered the subject of disease, than by giving
a few extracts from the work of Dr. Thomas King Chambers,
called Renewal of Life. He says, "M. DeVergie observed at
the morgue in Paris, that for two months and a half after de-
cease, the muscular structures still keep their natural forms and
hues." "Up to three months and a half the scalp, eyelids, and
nose so far retain their ordinary features that the age of the per-
son may be told." Dr. Chambers goes on to say, "We may
reckon with Drs. Bidder and Schmidt that the body of a mam-
mal contains 35.45 grammes of nitrogen per kilogramme; and,
therefore, that an animal of one hundred and thirty pounds
(which is the mean weight of a man) contains upward of forty-
six pounds of nitrogen."

" Then again, taking our numbers from an equally sound and
independent source, we may reckon with Baron Liebig that the
liquid and solid excreta of a man by kidneys and bowels for a
year contain 16.41 pounds of nitrogen, or for three months and
a half 4.7 pounds of nitogen." That is to say, in three months
and a half a quantity of nitrogen is removed by excretions, or
vital decay, equal to the quantity of nitrogen in the whole mass
of the chief nitrogeneous tissue."

The Renewal of Life. 183

What attraction has this term of three months and a half for
us? What memories does it rouse? Why, this was the very
time we fixed upon for the fleshy framework of the corpse to
melt away in. Here is a frequent fact, a light thrown on the
mysteries of nature from a most unpromising source! Dead
flesh and living flesh last as nearly as possible the same time —
the former, if any thing, rather the longer.

As far as we can judge, the albumen, fibrin, gelatin, etc.,
which make up the living body, differ in nowise from the same
matter dead; they are liable to the same changes; affected by
the same reagents ; and naturally are resolved into their element
in the same time; just as the marble in the Apollo Belvidere
is to a mineralogist the same stone that it was in the quarry,
liable to the same accidents and possessed of the same proper-
ties, though temporarily endowed with a different value and
made godlike by its adventitious form.

"What, then, raises to the rank of living creatures, and
clothes with loveliness the masses of organic matter which are
growing, moving, breathing, thinking, all around us? It is the
power of individual life to create its own individual form. A
man has no right of property over the particles of his body,
except so long as they remain particles of his body and retain
his shape. He hardly calls his the snippings of his hair or the
parings of his nails, much less the carbonic acid he exhales from
his lungs or skin ; all that he throws off is by common consent
claimed as a perquisite by the public ; and the battle-fields which
we have fertilized with his blood, enrich, not him, but the peace-
ful farmer. Yet as long as these organic constituents retain the
form impressed upon them by the individual life, they are more
truly his than any portion of his inheritance.''

"A conjectural theory has been hazarded, that life mysteriously
endows living matter with a defensive virtue, which enables it
to resist the chemical and other powers acting regularly on inor-
ganic and dead matter. The most notable instance cited is the
stomach, which, digesting every thing else, is not itself digested.
This consumer of flesh is itself made of flesh, yet it is not con-

184 The Renewal of Life,

sumed. An answer seems given to the witty philosopher, who,
on hearing an alchemist boast his discovery of a universal sol-
vent, inquired, * In what vessel do you keep it ? ' The stomach
says (it had been in the habit of saying wise things even before
the time of Menenius Agrippa), ^ In a vessel like me, which is
destroying, indeed, continuously, but is continually rebuilt.' Re-
cent researches show that living matter, such as parts of living
animals swallowed for instance, is dissolved by the gastric juice,
and moreover, that its own epithelial coat is destroyed, but is
immediately replaced by a new one. By this activity of growth
(the idea of the impudent members calling the belly large !), and
by a constantly flowing supply of alkaline blood to neutralize
any of the acid secretion which might penetrate too deep, it
retains the same shape for threescore years and * ten. But it
has no privileged immunity against the solvent it makes."

"It is then the form which constitutes the self; and it is not
the changing, decaying matter which ^ was mine, is his, and may
be slave to thousands.' The organic materials are the property
of the form only so long as it retains them, and no longer — they
are a floating capital. Over the innate essential nature of the
material it has no control. Life can not make the brute mate-
rials which it uses live longer than that which it leaves unused,
but it has the power of making them anew, and building them
up into a certain shape for the time they are made to last. In
short, life rests on the metamorphosis or renewal of the body;
as this renewal is more thorough, the individual is more^perfect,
and fulfills better and more completely the duties of its position.
If it stops altogether, the body is no longer living. If it par-
tially stops, the order of normal phenomena is deranged, and ease
is expelled. There is a state which we call dis-order or dis-ease."

"To speak, therefore, of 'a superabundance of life,' or an
'excess of vital action, is a contradiction in terms. There can
not be too active a metamorphosis of the tissues into their com-
plete form, for the fresher their organic constituents the more
serviceable they are, and the longer duration they have before
them. There can not be too close an adherence to that typical

The Renewal of Life, 1 85

form which it is the business of metamorphosis to keep up, any
more than there can be too exact an obedience to law and order."

^^The most active metamorphosis of the body possible, the
the highest development of life in every part, is health."

" The complete cessation of metamorphosis is death."

"The partial cessation, or the exhibition of materials in ar^
incomplete form, however copious they may be, is disease."

"In death the flesh goes on being decomposed as during life;
but not being renewed, the form" is lost entirely. In disease
decomposition goes on, but renewal flags, the incomplete tissues
are retained as part of the imperfect body — a sort of ^ death in
life^ — and are rightly termed by the pathologists ^degenerate.'
They are generated but not regenerated; they are generated in
an inferior mold of form."

The above extracts contain, as in a nutshell, the received
scientific opinions of to-day as to the nature and philosophy of
disease. They are based upon the physiological teaching to
which I have so frequently referred in these pages, and they are
very logical deductions from that teaching. I maintain that the
theorem and the corollaries deduced from it are equally false and
absurd.

There are laws which govern every thing, from the falling of
the grains of sand on the bottom of the ocean, to the formation
of the strata of rocks, which make up the crust of the earth;
and from the growth of a blade of grass to the revolutions of
the planets, suns, and stars in space. But these laws are sepa-
rate, unlike, and distinct. Animal life is made up of four orders
or divisions : radiates, mollusks, articulates, and vertebrates. But
these do not differ more, the one from the other, than do the gen-
era, family, or species into which they are subdivided.

When we come to man, the physiological and pathological
life of a negro differs in many particulars from that of an
Anglo-Saxon or Teuton. The same may be said of an Amer-
ican Indian, and some of the Asiatic races. But in all it is life.
The laws which govern the charnel-house, which govern decay
and rottenness, are peculiar to their own dominion. They may

186 The Renewal of Life.

invade the territory of vitality, but life retires as they advance.
There is a very striking illustration of the permanency of the
human organism in the mental faculty of memory. Many per-
sons leave their homes and go to foreign countries, where they
remain for a long time. After ten, twenty, or thirty years they
return to the place of their birth, when a tree, the old paternal
roof, or something, awakens memories which had been long for-
gotten, memories which would have never been recalled but for
these awakenings. During this long interval the whole body,
including the brain, had been entirely renewed, perhaps several
hundred times, according to the theory of Dr. Chambers.

If you say that memory is a faculty of the mind, or of the
soul — of something immaterial — then you must say that dogs,
horses, and elephants, possess this immaterial something, call it
mind or soul as you will, for they too possess the faculty of recol-
lection after many years. I could give many interesting facts in
proof of the memory of dogs, horses, and elephants. My expla-
nation is, that all knowledge, however acquired, is photographed,
so to express it, on the brain-substance, and that the brain-sub-
stance lasts as long as memory exists. It may be obscured — we
call it forgotten ; but incidents, like the rays of the sun's light,
again will bring it to view, or make it perceptible to thought.

Destructive metamorphosis takes place when a man's body is
losing weight, or the individual man is sick. But this disassim-
ilation is under control of the vital law. Constructive metamor-
phosis or assimilation never operates in a living being while the
body is losing weight.

The nitrogen referred to by Dr. Chambers was thrown off
from the body, not by a destructive metamorphosis, as he sup-
poses, but in the conversion of food into blood, as I have so fully
explained.

The opinions expressed by the distinguished London physi-
cian, are made the basis of a false and very injurious medical
practice, to which I shall hereafter more particularly allude.

In passing from a physiological to a pathological considera-
tion of the secretions, of the excretions, and of the blood, I will

The Renewal of Life. 187

first notice the circulation of the blood under some of its phases,
which, I think, are but little understood. I know that I have
been able to do but little justice to the subjects about which I
have written. But circumstances have prevented my doing bet-
ter. It is the particular object of this book to treat of the secre-
tions and excretions as the all-important matters to be considered
in the treatment of disease. It is also my purpose not to defend,
but to explain, what may be called old-fashioned practice. I am
not defending any thing ; I am overthrowing error ; error which
assumes to call itself scientific; error which is killing its thou-
sands annually. It is my purpose to explain what functions the
liver performs in a sick man, and how to regulate those functions.
It is my purpose to explain the action of calomel, and to show its
great value in the treatment of disease. I intend to show that
Hippocrates, Galen, and Celsus, besides hundreds of other dis-
tinguished physicians coming down from their time, were not
fools when they paid particular attention to the stools ; that when
they speak of bile — black bile, green bile, and yellow bile — they
speak of realities which they saw, and not of suppositions which
they imagined. I think I will be able to prove my positions to
the satisfaction of every intelligent and candid thinker.

This leads me to the consideration of the subjects treated of
in the next chapter.

188 Emetics and Cathartics,

CHAPTER XI.

Emetics and Cathartics.

As both emetics and cathartics, medicinally considered, have
a special reference to the secretions and excretions; to the circu-
lation of the blood, its congestion or hyperemia in different parts
of the vascular system; to digestion proper; to the formation of
effete matter and its removal from the body, I have written what
appears in the foregoing pages.

No man will ever use either emetics or cathartics judiciously
in the treatment of disease who does not clearly understand the
questions I have discussed. I do not pretend to say that I have
made them clear. No man can be more sensible than I am of
the imperfect manner in which I have investigated these sub-
jects. What I think I have accomplished is this: I think I have
pointed out the true method of investigation. It is for younger
and more able men than myself; it is for men who can see to read
and write to follow the path which I have pointed out, as the
woodsman blazes a tree here and there as he proceeds through
a primeval forest. After him comes the horse -path, then the
wagon-road, and next the railroad and telegraphic wires. It is
for younger men to accomplish what I have been unable to do.

The compass of truth has directed me.

I was born in Middlesex County, Virginia, within ten or
twelve miles of the Chesapeake Bay. During my infancy my
father removed to Richmond County, on the north side of the
Rappahannock River, where I lived until I was twenty-two years
old. This is the tide- water region of Virginia. On one or the

Emetics and Cathartics. 189

other side of the Rappahannock River there are marshes extend-
ing as far, I believe, as Fredericksburg. The same thing is true,
I think, of all the rivers emptying into the Chesapeake Bay.
This is the ague-and-fever and bilious-fever country of Virginia.
These fevers have prevailed in that country every summer and
autumn since Captain John Smith first landed at Jamestown.
After I was old enough to remember, I had the ague and fever
a part of nine successive summers or autumns. I remember
well that I looked forward to the first frost with anticipated
pleasure, for I had learned that these fevers ceased to prevail after
a hard frost. I did not escape these fevers till I was old enough
to be sent from home at a distance to school. Since then, when-
ever I have sojourned for a time in miasmatic districts I have
had either ague and fever or bilious fever. It is reported of
Celsus, the great Roman physician, that he, too, was born in a
miasmatic district, and that he never recovered entirely from the
eifects of these fevers until he removed to a more healthy coun-
try. The white population in this region of Virginia are short-
lived, very few reaching the age of seventy. The negroes, on
the other hand, live to a good old age, many of them living to
be very old.

The most common form of this miasmatic fever was ague
and fever. I do not recollect of ever hearing of any one
dying of ague and fever; though that form of disease seemed
to weaken the constitution more than bilious fever, from which
there appeared to be a more complete recovery. The method of
treatment in both was to commence with an emetic. The usual
time for giving an emetic was when the first indications of the
chill or ague began to manifest themselves. The emetic medi-
cines used were, for the whites a teaspoonful of ipecac and six
grains of tartar emetic mixed in about eight ounces of warm
water. A tablespoonful of this mixture was given to an adult
every ten minutes until he began to vomit freely, when he was
made to drink plentifully of warm water, until he had drunk a
half gallon or more. To the negroes was given a different form
X)f emetic — that is, to adult negroes. The same quantity of

190 Emetics and Cathartics,

tartar emetic and half an ounce of the sulphate of soda (Glau-
ber's salts) were mixed in about eight ounces of warm water, and
a tablespoonful of this given as in the other emetic, with the
drinking of warm water, as in the other instance. This latter
dose acted as an emetico-cathartic ; and I well remember that
the negroes got well in a shorter time than the white people.
Both forms of emetics caused the liver to secrete bile freely,
and to pour it out into the duodenum. I well remember vomit-
ing bluish, greenish, and then yellow bile in great quantities,
and I have seen many a patient do the same thing. In these
instances the liver was certainly forced to act.

A great deal has been said in recent works on physiology
about Pettenkofer's test for bile. There can certainly be no
better test instrument for bile than a man's mouth, and I have
tasted it too often to mistake the reality of its presence. The
appearance of the bile vomited was exactly like that which passed
from the bowels in my own case, alid in that of hundreds of stools
which I have examined as a physician. The stools to which I
refer were those which followed calomel given in sufficient doses
to excite the action of the liver. The effect of these emetics
was first to arrest the chill or ague, and then to produce a copi-
ous perspiration. This was followed by a feeling of great com-
fort, and by a calm and refreshing sleep. After the emetics, and
when the stomach had become entirely quiet, a dose of calomel
was usually given. At the time to which I refer Peruvian barks
were very generally in use. Quinine was high-priced, and very
sparingly used. One or the other was given to anticipate the
chill or ague. Many a nauseous dose of Peruvian bark have I
taken.

Jalap and Peruvian barks were very frequently administered
together, with an occasional dose of calomel. Under this treat-
ment the recoveries were generally quick, and, unless there was
some imprudence on the part of the patient, there were very few
relapses.

I have said that the recoveries were, for the most part, quick ;
and that while living in Virginia I never knew of any one dying

Emetics and Cathartics. 191

from ague and fever. Then why was the white population short-
lived, and why were the negroes long-lived? In answer to the
latter, I can only here briefly state several facts. To answer the
question fiilly would require me to go into a lengthy disquisition,
which is apart from the subject I am considering.

It is a well-known fact, that in all miasmatic countries and
in the tropics, negroes enjoy incomparably better health than do
white people, especially that branch of the white race known as
the Anglo-Saxon.

Du Chaillu relates that he found the negroes in equatorial
Africa fully developed men and women with well formed limbs,
sleek and fat, while he found it necessary to take tablespoonful
doses of quinine evety day to keep him from succumbing to the
influence of the miasmatic poison. Although he lived through
it, he became sallow and thin in flesh.

In answer to the second question, why the white race is short-
lived in miasmatic regions, it will be necessary to go into a some-
what critical examination.

Dr. Daniel Yaughan published in the London, Edinburgh,
and Dublin Philosophical Magazine, and also in several Cincin-
nati Journals, an article or articles on " The Chemical Nature of
Malaria.^' Referring to the fact that an analysis of the air had
failed to discover the cause of its insalubrity in miasmatic local-
ities— that no connection could be traced between the prevalence
of diseases and the complement of oxygen, nitrogen, or carbonic
acid in the air, he advances the opinion that volatile oils dis-
engaged from plants which are in a state of decay or decomposi-
tion under the influence of solar heat, are the efficient cause of
all miasmatic fevers. He supposes that these volatile and fer-
ment oils, when disengaged, arise into the atmosphere in the
form of vapor, and in that form are received into the human
system with the inspired air.

Dr. Yaughan shows clearly why this poison is most efficient
or deleterious during the night, and why it also exerts a more
injurious influence when the atmosphere is filled with moisture.
Dr. Yaughan's valuable article will, no doubt, engage the atten-

192 Emetics and Cathartics.

tion of scientific and philosophic thinkers every where. It will
not do to say that these volatile and ferment oils have not been
detected in the atmosphere of the most deadly localities. Since
the infinite divisibility of matter has come to be so clearly under-
stood by scientific experimenters, indeed I might say, since it has
been so demonstrably proved, it can not be denied that organic
substances may float in the air in forms so inconceivably minute
that they can not be detected by any test.

After these volatile and ferment oils, in a state of vapor, are
received into the human body, Dr. Vaughan thinks, if I under-
stand him correctly, that they were solidified or became resinous
by oxidation; and that in that form they obstruct the minute
blood-vessels. Whether this supposition is correct or not, I am
not prepared to say. This much I know: some years ago I
visited the water-cure establishment at Brattleboro, Vermont. I
became well acquainted there with many gentlemen patients who
had been old tobacco-smokers. They quit the pipe or cigar when
they entered the institution. These gentlemen told me that after
they had been packed in the wet sheets for several weeks, the
sheets continued to smell of tobacco. It is not possible for a man
to undergo a more complete sweating than is produced by water-
cure packings; and yet the tobacco which had entered their
systems, in the form of vaporized distillations, continued to re-
main in the blood and tissues of their bodies. I think there is
the highest degree of probability of the truth in Dr. Vaughan's
theory. If it be true, then the system may be supercharged
with the volatile and ferment oils received into their bodies by
respiration, when the individual so supercharged has one form
or the other of remittent or intermittent fever. We know that
Anglo-Saxons even, may become to a certain extent acclimated to
a miasmatic country; that they raise families who become compar-
atively stout men and women, enjoy good health, that is to say,
they become accustomed to miasmatic poison, and are enabled to
tolerate it in their systems; yet being subjected to the influence
of the same poison every summer and autumn, they finally suc-
cumb to it and are short-lived.

Emetics and Cathartics, 193

Up to the time when Dr. Elisha Bartlett published his valu-
able work on typhoid fever, the most apparent assignable cause
for the existence of that fever in Paris, France, was recent resi-
dence. According to his investigations into medical reports and
books written by the most distinguished physicians, this was the
conclusion arrived at by them. Medical students from the coun-
try, and strangers sojourning in Paris for a time, were almost
sure to have typhoid fever.

After reading Les Miserahles, I immediately perceived that
we could go one step further and show why recent residents were
more liable to take this form of fever than persons who had
lived in Paris many years. Victor Hugo gives a graphic account
of the tons of accumulated animal and vegetable filth in the
sewers of Paris. The cause of typhoid fever, then, in Paris, is
a compound ferment oil, escs^ing into the atmosphere from the
accumulated animal and vegetable filth existing in those sewers.
This, I doubt not, is the cause of typhoid and typhus fevers
every where. The old residents of the city have been accustomed
to breathe it from their childhood and were less affected by it,
while visitors were immediately poisoned by breathing these fer-
ment oils diffused through the atmosphere. No doubt persons
born there, both young and old, have typhoid fever. So it is
also in miasmatic regions. Strangers from healthy countries
visiting them when the malarious poison is most active, suc-
cumb to its influence, while many old residents enjoy good health.
We thus see that while volatile and ferment oils escaping from
plants produce intermittent, remittent, and yellow fevers, ferment
oils escaping from decaying animal and vegetable matter com-
bined, produce typhus and typhoid fevers. The first class of
fevers being called, from time immemorial, idiopathic fevers,
because no lesion is discovered ; the second class having pathog-
nomonic degenerations or lesions. We all know that smallpox
can be produced by inoculation, but we also know equally well
that if a healthy person, who has not been vaccinated, goes
within thirty feet of an individual suffering under smallpox, in
certain stages of that fever, he will take the disease and have it

13

194 Emeties and Cathartics.

with the same severity as if he had been inoculated with the
smallpox matter. We see then that an individual can take
smallpox by breathing volatile matter escaping from a smallpox
patient. Now the amount of this volatile matter is so infinitesi-
mally small that chemists have never been able to detect any
difference in the air of a smallpox pest-house, to distinguish it
from the air of the surrounding country.

In the case of this particular infectious poison breathed into
the system, it requires, in almost every case, twelve days for it to
begin to disturb the economy of the system. A very noteworthy
instance of this is given by Dr. Thomas King Chambers, in his
book already referred to. He relates a case of an individual
recovering from typhoid fever who was accidentally exposed to a
smallpox patient. The individual went on to improve daily and
to increase in flesh up to the twelfibh day, when the symptoms of
smallpox began to manifest themselves, and the patient had a
regular attack of smallpox.

As to miasmatic fevers, sometimes after a sojourn of a single
night, as in the Pontine marshes near Rome, the poison is so con-
centrated and malignant that a fatal attack is immediate. But,
as a general rule, the miasmatic poison, as well as the typhoid
and typhus fever poisons, has to accumulate in the system, or
requires time to effect certain changes in the system which ter-
minate in a peculiar form of fever. There is, then, in each of
the cases referred to, a certain form of poison received into the
system, a cause which, being present; makes the disease ; being
changed, changes it; being taken away, removes the disease;
more concisely expressed as follows : Causa, quae prcesens, mor-
bum facit, mutata mutat, suhlata tollit The question is, can we
change or remove this materies morbi, this cause of disease?

Let us see.

Men may speculate as to the efficient or proximate cause of
idiopathic or symptomatic fevers ; but there can be no speculation
as to the cause of smallpox. It can not be denied by any one
that this form of exanthematous fevers is as malignant, as viru-
lent, as fatal as any other form of fever. Sometimes smallpox

Emetics and Cathartics, 195

prevails under a mild type. During some seasons miasmatic and
enteric fevers prevail under a mild form. If we can modify or
lessen the severity of smallpox, we certainly can effect as much
as to both miasmatic and enteric fevers.

Asiatics discovered, centuries ago, that smallpox could be
made a comparatively mild form of fever. The method intro-
duced from Turkey into England by Lady Mary Wortley Montagu
was to prepare the system of the individual to be inoculated by
dieting, by bathing, and by medicines, if necessary, and then to
inoculate with the smallpox matter. The same thing is done
to-day by the most successful surgeons in preparing their patients
for operations.

I have as high an appreciation of the invaluable discovery of
Dr. Jenner, as had the great Napoleon, who said to the Empress
Josephine, " That man can be denied nothing.'' But vaccination
is so carelessly and imperfectly performed that smallpox fre-
quently prevails as a severe epidemic all over the United States.
Some physicians believe, even now, that it would be better to
inoculate after the method of the Asiatics. I do not think so,
but what I have said clearly establishes the fact that smallpox
may be made mild in form and character.

Proper dieting and cleansing of the body by washing with
warm water are well enough, and all-important, but the most
efficient means of preparing an individual who is liable to have,
or who is certain to have smallpox, miasmatic or enteric fevers,
is a thorough emetic.

Whatever may be the cause of the fevers just referred to, the
first effect and the continued effect is to interrupt and prevent the
conversion of food into blood. The function of every excreting
and secreting gland in this complicated operation is disordered.
Here arises within the body a new materies morbi, or cause of
disease. Each of the fever poisons referred to, and the list may
be extended to all forms of exanthematous fevers, as well as
some other maladies, has the determinate power to fix the dis-
tinct and peculiar symptoms which follow, which symptoms are
called pathognomonic, and entitle the fever to be called by this,

196 Emetics and Cathartics.

that, or another name. But they all agree in this, they interrupt
and prevent the conversion of food into blood. They do this from
the very beginning. They take away the appetite or make it
capricious or unliealthy. The food is mixed in the mouth with
the saliva, which is not healthful. In the stomach it does not
meet with pure, healthful gastric juice. In the duodenum it
meets with pancreatic juice equally deficient. All this, as I
have clearly shown, is but the beginning of digestion or the
conversion of food into blood.

When the fever poison is received into the body there is a
struggle between the destructive force and the vital energies.
This destructive force has a power within itself which deter-
mines its own progeny, and gives to that progeny a particular
name; but it also has the power to impoverish and to vitiate the
soil, so to express it, on. which it feeds and in which it is devel-
oped. The more completely the natural, healthful functions of
the body are disturbed and altered, the more completely the
secretions and excretions are arrested or perverted, the more
severe will be the fever in the individual case, call it smallpox,
intermittent or remittent fevers, or enteric fevers. Now, in this
struggle between the destructive and vital forces, the all-impor-
tant thing for the physician to do is to maintain the latter.

In all forms of fever there is a feeling of indisposition of
shorter or longer duration, but in every form, I believe, without
exception, there is a sensation of chilliness, amounting sometimes
to a distinct chill or ague. Now begins a manifest disturbance in
the circulation of the blood.. There is, during this stage, weak-
ened action of the heart with its necessary consequence, conges-
tion in the venous cavity. The sequences or consequences of
this congestion, more or less continued, and recurring at inter-
vals more or less regular, have already been referred to.

It was at the commencement of this stage, as I have already
said, that emetics were given in the tide-water region of "Vir-
ginia in the treatment of miasmatic fevers. It may be a question
with some whether the fever poison can be removed or eliminated
from the body. I do not doubt that it can be where the fever is

Emetics and Cathartics. 197

of miasmatic origin. Passing by my own experience and personal
observations in that region I have, during many years' practice,
succeeded in cutting short such fevers in two or three days.

The first thing I do is to give an emetic and vomit the patient
thoroughly. It is a great mistake to suppose that emetics are
only needed where there is an accumulation of food in the stom-
ach. I will refer to th^t state of the case hereafter. Unless I
have a reliable nurse I give emetics, and do not prescribe them.
Every one who never witnessed the operation would be surprised
to see the amount of thick, ropy mucus which is sometimes vom-
ited up. By holding it up you will sometimes observe a cord a
yard or more in length. Besides this viscid mucus, large quanti-
ties of bile are also vomited up. It would seem that the stomach
possessed the morbid faculty which the lungs sometimes possess
in chronic bronchitis — of separating or secreting this morbid
mucus from its mucous membrane. By being thus thoroughly
cleansed the stomach is put in a good condition for the reception
of food which would have been disgusting before the stomach
was cleansed. The liver being forced by the emetic to secrete
and pour out bile, the circulation of the blood through that
large gland becomes regular and active, and thus the congestion
in the venous cavity is removed. This applies particularly to all
the abdominal veins, and to the portal veins more particularly.
The liver may be forced to act, partly by mechanical action by the
movements of the diaphragm in the act of vomiting, when there
is deep inspiration and full expiration, and by the compression
of the abdominal muscles. These loads being removed, the
action of the heart becomes freer and fuller, and the arteries bear
healthful currents of blood to the remotest parts of the body.
But besides this there is another function fully established, viz.
the perspiratory functions of the skin.

When I give an emetic I am always careful to see that the
bed-clothes are kept well around the body, and when they partly
rise up to vomit I pull the bed-clothes up around their shoulders,
and I am always positive in my directions that the bed-clothes
shall be kept around the patient until the perspiratory action sub-

198 Emetics and Cathartics.

sides of itself. A sweet, quiet sleep commonly follows an emetic
thus given. If the patient wants any plain, simple food, I allow
him to have it. After this, if I think it necessary, I give calo-
mel alone or in conjunction with other cathartics.

If it is a case of intermittent or remittent fever, I then give
quinine or some preparation of Peruvian barks. The emetic
has removed the first difficulties, the calomel or cathartics have
given them an additional kick, and the preparation of Peruvian
barks complete the cure. Sometimes, and very frequently, the
remedies have each and all to be repeated. But I have had cases
enough to establish the fact positively that even severe cases of
miasmatic origin may be entirely relieved by one such round of
medicines.

I saw a man whom I visited twice. He had had ague and
fever for several months. I treated him as above stated. He
told me a month afterward he had not been sick a day since.
The quinine and cathartic pills I generally continue to give for
some days. An emetic thus given always arrests the chill or
ague. As soon as the patient begins to vomit freely, reaction of
the heart commences, and you soon perceive a full, strong pulse.
Animal heat, depending to a great extent on the force of the
I heart's action, upon increased motion in the current of the circu-
lation, begins to be reestablished in a healthful manner. The
internal congestions are at the same time entirely removed, and
a healthful though not excessive perspiration follows. The appe-
tite is restored, and all the organs engaged in the conversion of
food into blood are again at liberty and free to sustain this life-
preserving function. How absurd it is to call an emetic thus
given a depleting remedy ! But physicians more frequently find
it necessary to give remedies when the chill or cold stage has
passed by. We have then to give them during the exacerbation
or hot stage of the fever. You can not cut short a fever so
quickly and surely when an emetic is given at this slage as when
it is given at the beginning of the cold stage; but still, even then
it is very effectual. It matters not what the form or the name
of the fever may be, whether it be an exanthematous fever, as

Emetics and Cathartics, 199

smallpox or scarlet fever; or whether it be an idiopathic or
enteric fever, emetics may be safely, advantageously, and cura-
tively given in the early stage of each and every one of them..
The heart's action being in this stage full and strong, the heat
of the skin being excessive, the tongue for the most part dry
and parched, and the thirst often very great, it will be found
that an emetic properly given will remove each and every one of
these difficulties, and there will again follow a moderate and
healthful perspiration. A quiet and refreshing sleep will again
follow this perspiration. It will also be observed that no head-
ache or pain in the back and limbs follows an emetic given at
the beginning of the cold or during the hot stage of the fever.
If these pains and aches are present during the hot stage they
will be removed, showing that the nervous system, in all of its
parts, is relieved from the burden of disturbing causes, and is
again able, healthfully, to perform its proper functions.

Now again the work goes on of converting food into blood in
every part of the body. The forces of vitality are thus enabled
to overcome the destructive forces, come from whatever quarter
they may. In continued fevers of whatever name, as in remit-
tent and intermittent fevers, emetics have sometimes to be fre-
quently repeated. The well-informed and watchful physician
must be the judge for the necessity of repeating them. When
properly given they never weaken the system, and they are
always followed by an improved appetite. The most dangerous
and fatal form of all fevers is the congestive form. Emetics do
more to break up and prevent this • dangerous pathological con-
dition than any other remedy. In fevers of miasmatic origin
quinine should always be given after the emetic to prevent the
recurrence of the cold stage. It will be found that the emetic
prepares the stomach for the retention of quinine or some other
form of Peruvian barks; and that these have a much more salu-
tary effect after the stomach has been thoroughly cleansed, and
after the circulation of the blood is healthfully reestablished.

I have said that I am satisfied that fevers of miasmatic origin
may be cut short or entirely removed in a few days. Can the

200 Emetics and Cathartics.

same thing be done in smallpox and enteric fevers? I admit
that it can not; but yet I am entirely satisfied that the forces of
organic or vegetable life will be better able to contend with the
disturbances occasioned by the poisons occasioning these fevers
now at work in the systems by the thorough working of a full
emetic. It is unnecessary to repeat again what a full vomiting
accomplishes. Physicians of all schools, I believe, agree that
exanthematous and enteric fevers have to run a certain course.
The length of that course has never yet been determined. It
may be compared to a course around which race-horses run.
Sometimes the track is smooth and easy; at other times it may
be deep in mud, and it is difficult for the best horse to get through
it at all. So it is in fevers. Now what the physician has to do
is to keep the track in a good condition. If you remove the
disturbances of the internal congestion on the one hand, or the
exacerbations, with a burning skin and parching thirst, on the
other, both and all of which entirely arrest the conversion of
food into blood, you will make the track easy and the fever
poison will pass over without disturbing much the individual
who may be said to own the race-course.

Emetics and cathartics best prepare or enable each individual
patient to receive and to convert the necessary modicum of food
into blood while his body is the habitat of the fever poison.
Even now a very large proportion of smallpox cases are fatal;
and we know that many cases of typhoid fever continue for
months before it can be said that the health of the individual is
restored ; and even then mapy are afflicted with weakened limbs
or other infirmities. I am fully satisfied that a few emetics prop-
erly given at or near the commencement of these cases, would
liave saved thousands of lives from smallpox; and would have
prevented the typhoid cases from being so protracted ; with this
additional and great advantage in both cases, that the entire resto-
ration to good health w^ould have been complete, without any
hindrance or drawback. I have practiced medicine over forty-
three years. I have not treated over a dozen cases of smallpox.
One of them died ; the first case I ever saw. The eruption was

Emetics and Cathartics, 201

confluent when I was called to see this case. I treat smallpox as
I do scarlet fever, by vomiting the patient freely at the beginning
of the malady. I will give one case.- It was a complicated one.
I was called to see a man of good constitution, fifty-four or fifty-
five years of age, on the 23d of November, 1872. He was suf-
fering intensely from acute pleuro-pneumonia on the right side.
His respiration was both painful and difficult. His skin was
very hot. His tongue was very dry and coated with a brown
fur. He complained greatly of an intense pain in his head and
back. His pulse was strong and full. Altogether the man was
extremely ill. I gave him an emetic, he vomited freely, throw-
ing the fluid from his stomach six or eight feet. After vomiting
he breathed easily and felt comparatively comfortable.

I had a large, warm mush poultice put over this man's chest,
which I directed to be kept warm during the night. I then gave
him twenty grains of calomel. When I returned home, I told
my family I believed I had been to see a case of smallpox. The
man was so extremely ill that I would not alarm him by telling
him that night that I thought he was taking smallpox. He slept
comfortably a good part of the night. When I saw him about
nine o'clock the next morning, I thought it advisable to repeat
the emetic. The calomel had not yet acted.

After the emetic was over, and my patient appeared to be
doing very well, breathing without difficulty and having a regu-
lar, full pulse, I then told him I thought he was taking small-
pox. He did not think it possible, as he was vaccinated when a
boy in England, and thought he had been exposed to the disease.
The eruption commenced making its appearance on the evening
of that day, and there was afterward a very full development of
smallpox pustules over his whole body. After the second emetic
I controlled the pneumonia with Norwood's tincture of veratria,
given in do^es of four drops every three or four hours, when the
patient was not asleep.

This man was not uncomfortably sick after the second day.
He ate corn -meal gruel and milk when he wanted it. The inter-
vals for giving the veratria were lengthened until he ceased

202 JEmetics and Cathartics.

taking it on the fourth day. The warm mush poultice was con-
tinued through the second day and night.

I believe if this man had been treated with placebos, or put
on the do-nothing practice, he would have died, and that too in
a very few days. As to feeding such a patient or compelling him
to swallow milk, or beef tea, it was nonsense to talk about it.
The only possible good it could have effected would have been
to make him vomit, which would have been something in the
right direction. His system was not in a condition to convert
food into blood. I put it in that condition by vomiting him,
and giving him the dose of calomel.

I consider the mush poultice and the veratria as adjuvants.
The liver was made to secrete bile freely. It was passed from
his bowels as thick as tar, and of a blackish and greenish color.
I omitted to state that the calomel was followed on the second
night by giving two five-grain pills composed of equal parts of
calomel, rhubarb, ipecac, and aloes. These were continued for
several nights, until the bile discharged was rhubarb yellow. I
very seldom give calomel in exanthematous fevers, and only gave
it to this patient because the pneumonia preceded the premon-
itory symptoms of smallpox. This man's system being well
prepared, the smallpox poison had an easy course to run, an(l
the patient was convalescent in a week.

I have treated a large number of what are called typhoid fever
cases. I use the expression " what are called.'' In my opinion
typhoid fever proper — dothinenterite of the French — only pre-
vails in this region of Kentucky as an occasional epidemic ; and
then it is for the most part confined to individual families, or
particular neighborhoods. A physician in full practice will see
every year, when there is no epidemic, one or more cases of
dothinenterite. But, for the most part, fevers prevailing here
are of a mixed character, depending upon volatile and ferment
oils which arise from both animal and vegetable matter in decom-
position. A more correct name for such cases would be a typhoid
form of miasmatic fever.

There is not, in such cases, so great a tendency to localize the

Emetics and Cathartics, 203

disease in the glands of the intestines. It is extremely difficult
to make a distinctive diagnosis at the beginning in these cases;
but I believe that in both it is best to begin with an emetic.
If the case turns out to be only a typhoid form of bilious fever,
its course may be limited to ten or twelve days, but if it turn
out to be a case of dothinenterite, the patient will be better pre-
pared for bearing up against the poison originating it; as I have
shown that it can be done in smallpox.

It has been so long since I read AndraPs Clinique — before it
was translated into English — that I can not be very positive, but
my recollection is that one of the most marked symptoms in the
typhoid fever cases reported by him was a greatly increased heat
in the skin. I believe that Chomel and Louis state the same
fact.

Now greatly increased heat of the skin is not a constant
symptom in the cases called typhoid fever in this locality, but it
frequently occurs. Increased heat of the skin is always asso-
ciated with increased force of the hearths action. This increased
force of the hearths action can not be constant. It is succeeded
by shorter or longer intervals of weakened action of the heart.
This weakened action of the heart always involves, as Dr. Cook
has so clearly and fully shown, congestion in the internal veins
having no valves. The thermometer frequently shows increased
heat in the internal parts when the skin is not correspondingly
hot. Shall I repeat again, that emetics properly given remove
each and all of these difficulties.

In the treatment of fever of all forms, and particularly in
fevers which have a more or less duration, whatever the physi-
cian expects to do he ought to do quickly. In enteric fevers
especially, after a few days, or a week at farthest, almost every
thing depends upon good nursing, with the observance of hygi-
enic rules correctly understood. But a great deal is to be accom-
plished and can be accomplished during the first week. All that
I pretend to do, or expect to be able to do, is to put the system
of the patient in a condition to convert food into blood, and as
far as possible to keep it in that condition. I have no doubt at

204 Emetics and Cathartics,

all of the medicinal value of cathartics, and especially of calomel,
in the treatment of miasmatic fevers. I believe also that they
may be used advantageously at the commencement of enteric
fevers; but after a few days I never give them at all in such
fevers.

There is another method of cure in the treatment of fever of
all sorts, to which I can only refer in this connection.

I allude to cold water.

James Currie, M. D., F.R.S., of Liverpool, England, pub-
lished in the latter part of the last century a book, which is
known to the medical world as Currie's Medical Reports. I
should have said was known, for the book is out of print, and
there is not one physician out of a hundred who has ever heard
of it. This work was written before the birth of Priessnitz, the
author of the Water-cure Practice; but yet the practice revived
by Dr. Currie, and so fully and philosophically presented to the
medical world, had been forgotten when the hydropathic practice
began to make a noise in the world, so that if a physician who
had made himself acquainted with Dr. Currie's invaluable work
attempted to use cold water in the treatment of fevers he was set
down as a hydropathist, and so called even by physicians who
ought to have been better informed as to the literature of their
own profession. So great has been the prejudice against hydro-
pathic practice that physicians who were afraid to say that their
life is their own, because of their ignorance, would never have
been induced to use cold water at all in the treatment of fevers
but for the continual occurrence of a multitude of so-called
accidents. I will give a single one. I could fill a larger volume
than this with the details of similar occurrences.

A distinguished lawyer of tliis city, now deceased, told me thai
he had an attack of miasmatic fever many years ago at the house
of a friend in Mississippi. He was treated by two or three physi-
cians, who pronounced his case hopeless. They would not allow
him to have a drop of cold water to drink, nor would they apply
any to his person to cool his burning skin. One night his nurse
went to sleep. He then crawled from his bed to a cool spring in

Emetics and Cathartics, 205

the yard, where he drank all he could drink. After this he lay
down in the spring, which was a large one, and remained there
till he felt comfortable. He then crawled back to his bed and
was soon fast asleep. The next morning he was convalescent,
but his ignorant and illiterate scientific physicians said it was a
miracle he had not killed himself.

A reprint of Dr. Curriers book, with notes, would be worth
dozens of the so-called scientific books which are presented to
the medical public every year and sold at high prices. I do not
confine myself to one remedy, which is too often the case in
experimental practice in hospitals. In the treatment of fevers
I use cold water, according to the instructions of Currie, in con-
junction with emetics and cathartics. The three together, used
at the proper time, and in the proper manner, will accomplish
more than all the other remedies put together. They all unite
and concur in one great desideratum, viz. to put the system in a
condition to convert food into blood, and to keep it in that con-
dition. As to the use of cold water in the treatment of fevers
generally and the use of cold water and calomel in the treatment
of typhoid fever in particular, the reader will find my views more
fully expressed in the appendix of this book.

But I must now return to emetics and state some other forms
of disease in which they are valuable. I will only add one word
more about cold water. The drinking of cold water and ablu-
tions with it are not at all incompatible with the use of calomel,
provided the physician understands how to use both.

Having alluded to the Water-cure of Priessnitz, I have only
to say, that, conducted as in the establishment at Brattleboro,
Vermont, in 1847, I have no doubt that the practice is well
suited to some forms of chronic disease; but a well-regulated
system of dietetics has a great deal to do with the cures. As a
system it is not at all suited to private practice; and in acute
diseases the directions of Currie are far better than any ever
given by an advocate of the hydropathic system; indeed, in a
conversation with the gentlemanly and well-informed proprietor
of the establishment at Brattleboro, Dr. Wesslehoeft, about Dr.

y^

206 Emetics and Cathartics.

Carrie's book, he said he had read it, and added, that he consid-
ered it altogether superior to any work he had ever read on the
use of water in the treatment of disease.

Hydropathy, as a system, has had its day. I have given one
case of pneumonia, complicated with smallpox, in which I con-
sidered the emetics the most efficient remedy. There is no more
successful method of cure in the treatment of acute pneumonia
than an efficient emetic, to be repeated if necessary. I almost
always follow it with calomel.

There is a notion now very generally received, that calomel
promotes destructive metamorphosis. It is founded upon another
error. Constructive metamorphosis ceases in all forms of acute
disease, when the body is losing in weight. Destructive meta-
morphosis, or disassimilation is then alone at work. The capil-
lary blood-vessels then remove from the solid organism certain
materials which become effete matter. Calomel forces or induces
the liver to separate a part of this effete matter from the blood
and to convert it into bile, which ha^ certain important duties to
perform. The removal of this effete matter does not weaken
the system; but indirectly prepares the way for constructive
assimilation. There is no form of bodily and mental suffering
in which emetics are more curative, than in that terrible malady
called delirium tremens, or mania a potu.

I have treated a large number of such cases. Two of them
died. One of them was a case to which I was called in consul-
tation. He* had taken morphine in large doses. The other was
the case of a man who had had repeated attacks of this terrible
malady.

I vomit these patients freely, and after their stomachs become
quiet, give them calomel and jalap, if their bowels are costive,
as they generally are, and calomel alone if they are not costive.
A quiet sleep will generally follow this method of cure. The
emetic has sometimes to be repeated; the cathartic always.

It will astonish any one who has never observed it, to notice
the black and offensive stools which first pass off. I continue
the cathartics until the stools become a rhubarb yellow. Under

Emetics and Cathartics. 207

this treatment the appetite very soon returns, and the digestive
organs are again able to convert the food into healthy blood.

After the secretions are beginning to be healthfully established,
if good broths, milk, and some other forms of food do not re-
move or quiet the nervous irritability, I then give some form of
anodyne. Among the best of these is a strong toddy of whisky
or brandy. In cases of threatened abortion I rely more upon
emetics than upon any other remedy. Sometimes, and very fre-
quently, the approximate cause of an abortion is undigested food
in the stomach. Sometimes the symptoms of colic are so mixed
up with the pains caused by the contraction of the uterus that it
is difficult to make out a correct diagnosis. In such cases I
always inquire as to the kind and quantity of food eaten and
when eaten. I will give a case.

Over twenty years ago a gentleman said to me that his wife
had had five successive abortions, that she y^'as then in the fourth
month of pregnancy, and he wanted me to try and prevent another
mishap. This lady had five threatenings more or less alarming.
I vomited her in every instance. At the fifth or last, near the
eighth month, she was so alarmingly ill that I feared that I would
not succeed this time. The mouth of the womb was dilated to
the size of a silver half dollar, and the contractions of the womb
were strong and frequent. I was called about the middle of the
afternoon. I asked Mrs. P. what she had eaten for dinner. She
said, nothing. I asked what for breakfast. She said, a little bread
and butter and a cup of coffee. She said she had eaten about the
same for supper the evening before. I then asked her what she
had eaten for dinner the evening before. She said, a hearty meal
of vegetables and meats. I gave her an emetic of mustard and
salt. She vomited up an enormous quantity of sour and offensive
vegetables and meats. She was immediately relieved and went
to her full time, when she was delivered of a fine, healthy boy.
She has had several since without any trouble. Could this woman
have been relieved by any other method? I prefer the mustard
and salt emetic in these cases, because it acts so quickly and does
not relax or prostrate the system at all. I put a heaping tea-

208 Emetics and Cathartics.

spoonful of salt and one of ground mustard into eight ounces of
warm water. This they swallow at a draught. I repeat the dose
every five minutes until they begin to vomit freely. I then give
the same quantity of warm water at a dose until the stomach is
thoroughly cleansed.

Emetics are among the most valuable remedies in case of
dysentery. In dysentery I would vomit with ipecac or lobelia.
And this leads me to speak of the different kinds of emetic
medicines. In cases of colic, depending upon undigested food
remaining in the stomach, I prefer mustard and salt, as above
stated. Where the bowels are costive, and I desire to cause the
patient to vomit bile, I prefer tartar emetic. I have found tartar
emetic particularly suited to the treatment of intermittent and
remittent fevers. But it is said that in the states further South
this fbrm of emetic can not be safely given. It prostrates the
system too much, and is too apt to run off on the bowels. Had I
any such apprehension I would vomit with lobelia or with ipecac
and lobelia combined.

Had Dr. Benjamin Rush or Dr. Nathaniel Chapman, of Phila-
delphia, or Dr. James Jackson, of Boston, discovered the emetic
qualities of lobelia, and had they, or either of them, recommended
it to the medical profession, it would have been considered one
of the most valuable of the emetic medicines, but being intro-
duced by an unknown man, and perhaps an illiterate man — I do
not know — who at once commenced a war upon the regular pro-
fession, lobelia has always been associated with the steam-doctor
system, and therefore discarded.

My motto being '^Aut viam inveniaviy aut faciamy" I do not
hesitate to try any thing when I have good reason for believing
that it possesses some real merits. Sometimes, as just remarked
above, it is not advisable to use the tartrate of antimony and
potash as an emetic; and sometimes I have found that ipecac
would not vomit. In such cases I use lobelia. It possesses this
very desirable and in many cases all-important quality, that it
does not excite the bowels, nor is there any nausea left after full
vomiting.

Emetics and Cathartics, 209

But Dr. Samuel Thomson is entitled to far more credit for
his method of giving an emetic than for the discovery of lobelia
as an emetic medicine. I allude to the giving of a warm and
stimulating tea at intervals of from five to ten minutes, say a
teacupful at a time, until a quart is drunk, before the emetic
medicine is given, which should then be repeated, as is usually
done until full vomiting succeeds. I use the powder which the
^' Thomsonians " call composition powder to make this tea. It is
composed, I believe, of ginger, capsicum, and bayberry leaves.
This will prevent the gagging, straining, and cramping in the
stomach. An emetic given in this way will be followed by a
more abundant warm perspiration, which is a desirable thing.
As I have once before remarked, the bed-clothes should always
be kept well around the patient while vomiting, and should be so
kept till the perspiration subsides of itself Let who will try this
mode of giving an emetic, I say to him that he will be pleased
with it and also very much obliged to me for having the inde-
pendence to recommend it.

From all that I can learn from books as to the nature of yel-
low^ fever, I have no doubt it is of miasmatic origin, and I do
not doubt that a stimulating emetic of lobelia and ipecac, given
as above directed at the commencement of the attack, would be
one of the very best methods of cure. I have used emetics in
many other forms of disease besides those named. But a man
may have a large practice, and still only find it necessary to give
an emetic occasionally. Ordinarily, in a majority of cases to
which a physician is called, there is no necessity for prescribing
so unpleasant a remedy. It is only in the severe forms of dis-
ease, and especially in epidemics which threaten life, that I find
it necessary to use them. The taking of an emetic is a very dis-
agreeable thing. It is for this reason that I attend to giving
them myself, and do not prescribe them unless I have an attend-
ant or nurse upon whom I can rely. Patients often say that they
can not take them at all, that they strain, gag, and cramp them.
I can assure them that an emetic given as I give it will do
neither, and I have never been disappointed.

14

210 Emetics and Cathartics,

I commonly have half a gallon of warm tea prepared; of this I
give three teacupfuls at intervals of five or ten minutes, and then
put the emetic medicine into the remainder of the tea. Com-
monly I make them drink all of this, and sometimes more warm
water besides. There is no remedy which leaves the patient feel-
ing so comfortable. It breaks up at once many forms of disease,
and prevents the long continuance of other forms which are
wearisome, painful, and sometimes fatal.

During the past summer I was called to see a gentleman at
one of the hotels who had just arrived from Cincinnati. It was
9 o^clock p. M. He left La Fayette, Ind., the day before. Being
deprived of his dinner, he ate a lunch of hard-boiled eggs, bread,
etc. This brought on cholera-morbus. He was a free drinker,
and no doubt drank too much whisky. The night before a phy-
sician gave him chloral mixed with something else. It did him
no good. He told me that the diarrhea was so continual that he
passed nearly all the time between Cincinnati and this city in the
water-closet of the railroad car. I found him nervous, restless,
and irritable, with a quick, watery pulse. His stomach was nau-
seated. I gave him a stimulating ipecac and lobelia emetic. He
vomited bile freely. After it was over he said, '^ Doctor, I feel
like another man, I am entirely relieved." I gave him nothing
else, and he slept comfortably all night. Next morning he ate a
hearty breakfast of beefsteak, bread, and butter.

I repeat again that an emetic is a disagreeable remedy, but
the forms of disease for which I prescribe it are far more disa-
greeable, with this great difference between them, that the taking
of an emetic is of short duration, whereas the uncomfortableness
and pains attending these same diseases are long continued, some-
times entailing, after apparent recovery, chronic ill health.

There is another form of severe malady in the treatment of
which I have found emetics a most valuable remedy. I allude
to spinal meningitis. That disease prevailed here last winter and
spring. I treated six cases, four whites and two negroes. They
all recovered. I do not say that my cases were as malignant a
form of the malady as some others, many of whom died. While

Emetics and Cathartics. 211

i

treating them I read over, in conjunction with one of our most
intelligent physicians, all that I could, find in the books on the
subject, particularly Andral, Flint, Watson, and the monograph
of Dr. Clymer. Three of the cases had opisthotonus. The first
case was a negro girl fourteen years old. She began to be deli-
rious on Wednesday, the opisthotonus commenced on Thursday.
I saw her for the first time on Sunday morning. The delirium
and opisthotonus continued for ten days longer. I kept her nau-
seated a good part of the time with ipecac and lobelia, and gave
her calomel at irregular intervals. At night I gave her a tinct-
ure of the root of aconite in doses of three drops mixed in a
tablespoonful of water every hour until she went to sleep. It
quieted her remarkably well. It would reduce the frequency of
her pulse and make it fuller. I applied ice to the back of her
neck, but did not see that it did her any good. This girl recov-
ered with the loss of one eye. Physicians who can see tell me
that the optic nerve is destroyed, otherwise she is perfectly well.
It was several weeks before she regained her strength. Her diet
was milk, beef, and mutton-broth, with Catawba wine after the
acute symptoms had subsided.

Case II. The mulatto man was twenty-five years of age,
well-formed and athletic. He had had severe pains in the head
for four or five days, and was seized the night before with a
spasm, which lasted, as his wife told me, over two hours. This
spasm returned next morning about daylight. I saw him about
nine o'clock A. M. His limbs were terribly cramped. His hands
were tightly clinched. His jaws were locked. His head was
thrown back and his neck was rigid, in a bent condition. His
pulse was forty. I attempted to open his mouth with a spoon.
There was a little relaxation, when I gave him nearly a tea-
spoonful of calomel. One of our physicians asked me after-
ward why I gave him so much ; I told him that I did not know
that I would get another opportunity to give him any thing, and,
that as many cases had died within twenty-four hours, I thought
I had " better make hay while the sun shines. " The calomel
acted like a charm. Within six hours the tetanus and spasmodic

212 Emetics and Cathartics,

movements had all passed off. To remove the stiffness in his
neck I afterward used twice the Georgia remedy. I applied to
the back of his neck and between his shoulders a thick strip of
flannel, saturated in spirits of turpentine, over this I rubbed a
warm smoothing iron. It blistered the skin slightly and relieved
the stiffness in his neck. I gave castor-oil to work off the calo-
mel, which given in large doses is very slow to act on the bowels.
This man^s pulse continued at forty for three or four days.' He
was convalescent in a week.

In the case of the girl the temperature of the body was some-
times a little warmer than natural, in the case of the man there
was not the slightest elevation of temperature.

Case III. The first case of the whites was a lady some sixty-
five years of age. There was no opisthotonus or delirium in
this case, yet I considered it a case of spinal meningitis. She
complained of intense pain in the head and back, with severe
cramps in her knees, ankles, and feet. I gave her an emetic of
ipecac and lobelia, and kept her on a nauseating mixture of the
same afterward until the severe pain subsided. She also took
pills composed of aloes, rhubarb, calomel, and ipecac. After
she had begun to improve the ' pains in her knees, feet, and
ankles continuing, and keeping her awake at night, I gave her
twenty-grain doses of the hydrate of chloral. This lady had
recovered but a few weeks before from smallpox. I treated her
for that malady. She said her sufferings during the smallpox
were nothing compared with what she underwent during this
last sickness. ^

The next case, the old lady's grandchild, was a boy two years
old. The child was extremely restless and apparently in pain.
The eyes became crossed within a few hours after the child man-
ifested any indisposition. I gave this child teaspoonful doses of
a nauseating mixture of lobelia and ipecac. This was continued
for ten or twelve hours. I then gave him enough of it to vomit
him freely. He then became quiet. I then gave hira two-drop
doses of the tincture of aconite. He slept comparatively well
during the night, having taken three or four doses of the aconite.

Emetics and Cathartics, 213

The next day, as the unpleasant symptoms were returning, I
gave him two-grain doses of calomel every six hours. I also
gave him an occasional dose of the nauseating mixture. The
aconite was continued at night. The child soon got well. In
neither of these cases was there any increase in the temperature
of the skin, if there was any in the child it was very slight. His
pulse was quick, the old lady's was not.

The next case was a young lady in her twenty-first year. She
was well-formed and in the bloom of womanhood. She had
been perfectly well up to the seizure. It commenced with in-
tense pain in the head and back. In less than two hours she
was delirious. There was no opisthotonus. I saw her at nine
p. M., between two and three hours after the seizure. After a
little trouble I succeeded in vomiting her freely. As this did not
relieve the delirium, I gave her twenty grains of calomel. I then
commenced giving her the tincture of aconite in three-drop doses.
The second dose quieted her, and she slept four or five hours.
When I saw this young lady early the next morning she was
rational. She still complained of the pain in her head and back
and annoying pains in her limbs. I repeated the emetic, and
also the calomel, and afterward kept her on the nauseating solu-
tion of lobelia and ipecac. At night she took the aconite. Her
nurse said this acted like a charm in quieting her. It was ten
days before the soreness and pains in her limbs passed off; but
she made a rapid recovery, and is now as well as she ever was.
She was slightly salivated ; the only one of these cases that was.
There was not the slightest increase in the temperature of the skin.

The next case was a young lady about the same age as the
last. There was slight opisthotonus, with severe pains in the
head, back, and limbs. I vomited her twice, and gave her the
cathartic pills above named. She also took the tincture of aco-
nite. I applied a flannel, saturated with the tincture of turpen-
tine, to her back and applied the warm smoothing iron. This
was repeated twice. There was no elevation of temperature in
her case. She recovered in a shorter time than either of the
other cases.

214 Emetics and Cathartics.

It will be seen that I used chloral in one of these cases and
the tincture of aconite in four of them. I relied upon the
emetics, nauseating mixtures, and cathartics. The other reme-
dies were simply adjuvants. The patients were all properly fed.
Lobelia is to be preferred to any other form of emetic medicine
in the treatment of spinal meningitis, because it produces relax-
ation more than any other article known as an emetic.

The late Dr. Benjamin W. Dudley, of this city, no less dis-
tinguished as a physician than he was as a lithotomist, used
emetics in the treatment of chronic diseases to a greater extent
than any other physician about whom I ever knew any thing.
He effected many astonishing cures in cases which had been con-
sidered incurable. His emetic medicine was ipecac and the tar-
trate of potash and antimony. He commonly gave an emetic
one evening and a dose of calomel the next night. This course
he often continued for several months. He used the emetics and
cathartics to effect this. Never perhaps was there a physician
more careful and particular in his system of dietetics. He always
prepared his patients for operations by dieting them and giving
medicines after this method. I have very seldom used emetics
in the treatment of chronic diseases, though I do not doubt the
value and efficacy of them in many cases.

Emetics constitute a valuable remedy in the treatment of
croup. Children can not be vomited like grown people. They
will not drink either warm water or warm teas. Antimonial
wine, wine of ipecac, tincture of lobelia, and syrup of squills,
are each useful in cases of croup. Sometimes it is very difficult
to vomit children having croup. We often have to try one med-
icine and then another. Sometimes I have found a mixture of
molasses, not syrup, and common table-salt to vomit when other
medicines had failed. I have vomited infants promptly with
this, with very quick relief. I also give calomel in the treat-
ment of croup. But after vomiting, if it can be effected, I have
more confidence in cold water than in any thing else.

I fold up an ordinary size towel and wet it in ice- water. This
I apply to the throat from ear to ear. It covers the throat as

SmetiGs and Cathartics, 215

low down as the sternum and clavicles. I could relate some
remarkable cures, but it is unnecessary. A light fold of dry-
flannel is put over the towel.

To recapitulate : Emetics act in various ways. When undi-
gested food remains in the stomach, causing colic or other
uncomfortableness, an emetic removes it.

An emetic may be said to be one of Nature's methods of
giving relief. Some of the lower animals, as dogs, vomit when
they are sick. It is said that the Roman epicures vomited when
they wanted to prepare themselves for the enjoyment of another
meal. Many persons can vomit at will when they find that the
food in the stomach is giving them trouble. But vomiting often
occurs in a shorter or longer time after eating without any effort
of the will; indeed these individuals can not prevent it. This
involuntary vomiting often affords great relief; but it does not
afford the complete relief which is given by medicinal vomiting.

This condition of the stomach is often the best indication for
giving a regular and full emetic. It is one of the best means for
quieting ^he nausea and retching, which often follows involun-
tary vomiting. The medicine selected must be suitable to the
case.

Drunken men are often completely relieved by involuntary
vomiting; and there is no better method to enable a man to get
over a " spree " than to vomit him freely and fully.

As I have before said, there is no remedy equal to an emetic
in the treatment of delirium tremens. But the cleansing of the
stomach is but a small part of the benefit secured by an emetic
properly given.

The lungs are continually throwing off a large amount of
effete matter in the form of carbonic acid and watery vapor.
When a man is well enough to work or to take exercise, he can
(^use the lungs to consume more oxygen and nitrogen — atmos-
pheric air — by the muscular movements which compel his lungs
to expand and to contract ; but when the individual is unable to
take exercise, then the only method by which you can compel
the lungs to expand and contract is full emesis.

216 * Emetics and Cathartics,

The mechanical movements involved, so to express it, effect
this. But not only this, an emetic will cause the lungs to secrete
and throw off mucus, as it does the stomach. An emetic regu-
lates the circulation of the blood. It causes the action of the
heart to become freer and fuller. It causes the blood to be dis-
tributed throughout every part of the body.

When the action of the heart is excited by a fever poison,
and there is a strong, full pulse, the same thing occurs ; but with
this difference, the increased and accelerated current of blood
caused by the fever poison causes or produces an increased
amount of caloric, which torments and wastes the individual;
whereas the accelerated circulation of the blood, caused by full
emesis, does not produce an excessive amount of caloric, but is
healthful and restorative. An emetic properly given produces,
from the beginning, healthful perspiration, which prevents excess-
ive heat, and which perspiration is another of the methods by
which the matter, which ought to be removed, is thrown off from
the body.

Emetics also force the liver to separate effete mattemfrom the
blood, and to pour it out into the duodenum in the form of bile.

Large quantities of bile are thrown off by vomiting. Some-
times much of it also passes off by the bowels.

These secretions or excretions being so fully established by
an emetic, the kidneys will act healthfully.

In doing all this, an emetic necessarily acts upon the capillary
system of blood-vessels, not only in the lungs, skin, liver, and
kidneys, but in every part of the body. These capillaries may
be said to be the mouths of the veins. They prepare whatever
the veins have to swallow. There are two distinct sets of them.
The one set is that system of vessels which takes up the food
from the stomach and intestinal canal and empties it into the
veins going to the liver. The other set is the system of capilr
laries existing in all other parts of the body. In perfect health
the blood is changed in this system from arterial to venous. It
loses oxygen and becomes filled with carbonic acid.

As I before said, when the body is fully grown, and there is

Emetics and Cathartias. 217

no increase in weight, nothing is added to the solid organism;
but when the body is losing in weight, which almost always
occurs in every form of sickness, then a part of the solid organ-
ism is removed in the form of effete matter.

The capillaries separate and remove this effete matter. It
passes from them into the veins.

Now, the effect of an emetic acting through the lungs, skin,
and liver, is to cause this effete matter so removed to be thrown
out of the body. It causes the action of this system of capil-
laries to be more vigorous and healthful.

The cooperation of all of these health-producing efforts pro-
duces tranquility in the nervous system, and gives to it vigor and
strength.

An emetic improves the appetite and enables the system to
digest the food eaten ; I mean to digest it according to my expla-
nation of the meaning of that expression. A healthier and
purer blood is sent to the brain and entire nervous system.

When these facts are fully and dispassionately considered, it
will be difficult for a physician to overestimate the benefits con-
ferred by this now very unfashionable remedy.

218 Cathartics.

CHAPTEE XII.

Cathartics.

If any one will read the latest essay on dew, he will find
very little in it which was not observed by Aristotle. Passing
from this, the greatest of Greek philosophers, the greatest per-
haps because he took the whole earth for his field of observation,
to Hippocrates and Galen, the greatest of the Greek, and to Cel-
sus, the greatest of the Eoman physicians, not to name many
other distinguished physicians who lived in those remote ages,
he will find that they too were close and careful observers of
nature.

Aristotle was the Cuvier of his age. His pupil, Alexander
the Great, gave him materials and opportunities for observation
and investigation which no other man among the ancients had.
The Greek and Eoman physicians had no such advantages.

M. Auguste Comte, in one of his essays, maintained that
sociology, or government, from the town corporation to the state,
kingdom, or empire, was the most difficult department of human
knowledge. Mr. J. Stuart Mill replied to Comte^s essay. He
reviewed the many and different departments of knowledge which
a man must know and understand to become a physician, and
declared that medical science was a more difficult department of
knowledge to be clearly and fully understood than sociology.

If we agree with Mr. Mill, then we must admit that the early
Greek and Roman physicians should stand among the first intel-
lects of their age. Like the first astronomers, their opportuni-
ties for coming at correct conclusions were very limited. They
described fevers in all of their stages with the greatest accuracy

Cathartics. 219

and truthfulness, but the observations which they made, which
come within the purview of this chapter, related particularly to
the stools.

Natural philosophers now know something about dew, or give
explanations about it which Aristotle could not give. He had
neither a thermometer nor a barometer. So can physiological
chemists explain as to the constituent elements of bile, but the
Greek physicians knew bile when they saw it, as well as Aristotle
knew dew wlien he saw it.

The bile which the Greek and Roman physicians saw, was that
which passed from the bowels or was vomited. They describe
it as yellow bile, green bile, and black bile. They noticed that
the different kinds of bile followed the administration of certain
medicines. They had neither a chemical apparatus to make an
analysis nor Pettenkofer's method of testing it. But they were
as certain that it was bile as Aristotle was certain that what he
called dew was dew.

There are men living in England, as well as some in this
country, who never get out of bed until the sun is two or three
hours high.

If any such were living in Greece at the time of Aristotle,
they might have said to him: "This thing which you are talking
about, which you call dew, is an optical delusion; we want you
to show it to us," but they would not change their habit of getting
up late. So if Aristotle gathered some of the dew and brought it
to them the next day, "Why this," they would say, "is water, and
we know that it did not rain last night." Then Aristotle would
take them out in the morning, after a shower, and show them the
water on the grass and leaves, and say to them, " These drops,
gentlemen, resemble dew." "But these," they would reply,
"we know to be rain-drops!" Then Aristotle would say, ''The
dew evaporates under the influence of the sun's rays, under the
influence of light and heat— it goes into the atmosphere." These
skeptics would deny the correctness of Aristotle's observations
because he did not prove them to their satisfaction. Modern
physiologists, not knowing what the bile is made of, or what

220 Cathartics,

becomes of it, deny that it is an excrementitious fluid, and
teach that it is reabsorbed.

Until very recently no one ever doubted that the facts
observed by the early Greek and Roman physicians as to bile
were entirely correct and true. We are told that bile can not
be detected in the feces by chemical analysis; that one of its
moet noticeable elements, cholesterin, is converted into stercorin,
and passes off with the feces as stercorin.

We are told that in the body of a healthy man of ordinary
size, two pounds and a half of bile are poured out every day into
the duodenum. I ask physiologists what becomes of it, as the
men asked Aristotle what became of the dew. They answer that
it can not form a part of the feces, for two reasons : First, because
it can not be detected in them by chemical analysis; and second,
because there is too small an amount of the feces ordinarily dis-
charged from the bowels of a man daily to account for the disap-
pearance of so large an amount of bile. But when I then ask
what becomes of the bile, they do not say that they do not know ;
but they say, whether changed or unchanged, it is absorbed.

Aristotle might have said that the dew went into the atmos-
phere; but these modern savans, having all the advantages of
chemical and microscopical apparatus, can not tell what becomes
of the bile. If it is absorbed by the capillaries of the intes-
tines, it must enter into the portal veins; but no physiologist
will pretend to say that bile, or any element of bile, can be found
in the portal blood of a man perfectly healthy.

But let us look at this question of the continued absorption
of bile, as a physiological fact in individuals entirely sound and
well. They affirm that the liver separates from the blood two
pounds and a half of bile every twenty-four hours. They admit
that the gall-bladder is a receptacle, or sort of storehouse to the
bile; but when it, or any of it, or all of it, is passed into the
bowels it is to be immediately taken up again, absorbed, and
sent back to the liver.

What need could there be for a gall-bladder if this conjecture
is right? Why this continual chain-pump arrangement?

Cathartics. 221

According to them, the bile has hardly had time to escape
into the duodenum before it is taken up and brought back
again to the liver.

But they tell us that the chief use of the bile is to assist the
pancreatic juice in preparing the food for absorption. But
according to them there is a great deal more bile poured into
the duodenum than there is food emptied into it from the stom-
ach, for very few persons consume two pounds and a half of
food a day.

As is admitted by all, a large amount of the food eaten passes
through the liver before it enters the general circulation. Now,
according to this modern doctrine, more bile than food is being
continually taken up and sent back to the liver.

The system of capillary blood-vessels, which absorbs the food
in the intestines, possesses, according to these savans, the wonder-
ful faculty of converting the bile into something so ethereal or
spiritual that it can not be detected in the portal blood.

I wish the reader again to refer to the table showing the con-
stituents of the bile. But these would-be learned men know no
more as to what the bile is made out of than they do as to what
becomes of it. They say that bile is not made out of effete mat-
ter, except cholesterin, a very small constituent part of the bile ;
and they deny that the liver forms or makes cholesterin. The
effete matter they send to the kidneys. But they say the bile is
made out of the blood. Then I would ask, what part of the
blood is it made out of? Is it made out of the fibrin, the albu-
men, or the red and white corpuscles?

One Avould suppose that if two pounds and a half of these
elements of the blood were consumed daily to be formed into
bile, there would not be much left to supply the constructive
assimilation, which they suppose to be continually going on.
Two pounds and a half of the vital material is consumed daily,
according to them, to form a fluid which is constantly being sent
back to the liver. The whole thing is absurd. I will now again
give my explanation of the bile from the beginning to the end-
ing of it.

222 Cathartics,

The flora and fauna, which inhabit this earth, agree in one
thing, they live to eat and they eat to live. That is the sum
total of vegetable and organic life.

Speaking of the animal kingdom, truly did Rasselas, a prince
of Abyssinia, exclaim, " What," said he, '^ makes the difference
between man and all the rest of the animal creation ? Every beast
that strays beside me has the same corporeal necessities with my-
self; he is hungry and crops the grass, he is thirsty and drinks the
stream, his thirst and hunger are appeased, he is satisfied, and
sleeps ; he rises again and is hungry, he is again fed and is at rest."

After conception, after the birth of the spermatozoon in the
utero— if I may so express it — all else is growth, depending on
nutrition.

Commencing at the lowest level, we find living entities so
simple in structure that it is difficult to say whether they belong
to the animal or vegetable kingdom. Presently we perceive
there is motion in them — motion evolving heat. They also pos-
sess the faculty to feed. The appetite of these simple beings
seems to include an elective attraction, for their food may be said
to come to them. This involves an absorbing system. Rising
one step higher, we find that these simple existences have loco-
motion with the ability to move in a particular direction ; and
rising another step, we observe also that they have the faculty of
sensation. These several faculties involve a brain and nervous
system, yet the structure of these beings is so simple that it
appears to be a homogeneous mass, the parts of which can not
be discovered by the most powerful microscope. Yet these
simple beings are perfect "after their kind."

Beginning at radiates, we find a development of animals per-
fect "after their kind" until we reach the highest of that order;
and so on through mollusks, articulates, and vertebrates, until we
arrive at man ; and he too is developed from a spermatozoon, as
simple in structure as was the organism of the little living entity
which we could hardly distinguish from a plant.

The fully-formed and perfect organs which we find in man, as
a bony skeleton, the heart, the lungs, the brain, etc., are but the

Cathartics. 223

representatives of distinct individual beings of a lower order.
These^ taken together, make up the order, and the perfectly-
formed organs in man make up the individual.

The different animals which make up an order, live an allot-
ted time, unchanged in any thing which constituted their indi-
viduality. The organs in man remain for their allotted time,
that is, during life, as unchanged and unchangeable as were
these individual animals.

When we say that a man or woman is grown, we mean that
all the organs are fully developed ; as we speak of separate and
distinct animals of another or lower order. It was a concur-
rence of parts which made each separate animal, and it is a con-
currence of parts which make each organ.

The organs are as permanent as the individual animals. Men
may waste from sickness or from starvation, and become living
skeletons, as did Captain Eiley in Africa, but that which they
lost in weight was no necessary part of their individuality as
animals. When a man, sound in body and mind, is grown, con-
structive assimilation ceases, and it is only renewed when there
is loss in weight from any cause. By constructive' assimilation I
here mean that which developed to perfection each organ of his
body. But a man may get fatter and his muscles may get larger.
Here, too, we have constructive assimilation, but of another
kind. It is the adding of something to the weight of the body
which was no part of the original man. It is these unneces-
sary parts which are removed by destructive metamorphosis, but
these two processes never go on at the same time. Destruct-
ive metamorphosis never begins until constructive assimilation
ceases.

On the other hand, constructive assimilation never begins
until destructive disassimilation ceases. Both of these functions
are performed through the system of capillary blood-vessels.

These capillaries have no glandular or catalytic power. From
the birth of the spermatozoon in utero, to full growth, each
and every organ, or the nucleus of that organ (I refer to proto-
bioplasm as defined by C. Heitzmann, M. D., as given in a

224 Cathartics.

former chapter) selects from the vital fluid floating in them, such
materials as are necessary for its formation and growth. But
the catalytic power is in the organ or the nucleus of an organ,
bones selecting bone-matter, the brain selecting brain-matter,
and so of the rest. But when destructive metamorphosis begins,
then the capillaries take up from the wasting organism of each
part whatever may be separated and thrown ofi*. The capillaries
do not separate compound substances, as urea and cholesterin,
for instance. Such compounds are formed from the homo-
geneous and heterogeneous effete matter, by organs having
glandular and catalytic powers, as the kidneys and liver.

I repeat, we find in the humbler forms of the lower orders,
animals whose organism is so mixed and undefined that we can
not discover in them any organs, and hardly the representation of
a nucleus of an organ; yet we discover in them a capacity to feed,
involving an absorbent system. We discover in them motion
and heat, involving a respiratory system, for there is no heat with-
out the consumption of oxygen ; we discover in them sensation,
with the power to move in a particular direction, which involves
sensitive and motor nerves, with a brain to direct. Now I main-
tain that the development of perfect organs in man is but the
representation of distinct living beings of a higher and higher
class among the lower orders, and that they are as permanent
and enduring in their forms.

Take the heart of man, for instance. It is nourished or fed
through a system of capillary vessels. It has within it motion
and heat. It is the seat of the emotions, and may be made
to flutter by a look; the force of its beat may be, and is, con-
tinually influenced by a thought. Its action may be stopped
at once, and sometimes forever, by what we see or hear. In
all that constitutes life, it is a more perfectly developed organ
than are many of the lower creations perfectly developed
animals.

After full growth — I am here considering a perfectly healthy
individual from conception to maturity — I maintain that if the
individual does not vary in weight, neither constructive nor

Cathartics, 225

destructive assimilation takes place in his body. What then, I
may be asked, becomes of the food, and what are its uses?

If any physiologist will make the calculation, if he will weigh
exactly all the food and drinks swallowed, and then weigh all the
excretions thrown off from the body by the lungs, by the skin,
by the bowels, and by the kidneys, he will find that they very
nearly balance. This thing was attempted by Mr. Grisenthwaite,
to whom I have referred, but there are so many errors in his
book that I do not think it is entitled to much consideration. I
suppose, however, the thing might be done with approximate
accuracy.

In a living animal spirit and matter are inseparable. God
created all living beings. In this creation he endowed matter
with life. Life or spirit causes the development of organs and
of animals. This is spirit acting on matter. In what we call
nutrition, or the giving of physical or intellectual strength to
man, may not vitalized matter or food give spirit, physical and
intellectual strength to the several organs making up this totality
without losing any of its material part? The union of the oxy-
gen with the fresh juice of the grape, or with the malt of beer or
ale, or the mash of corn meal and water in making whisky, gives
strength, body, force, stimulating and intoxicating qualities with-
out adding any material to the substance of either; so the force
of vitalized matter upon the organized tissues — tissues according
to Bichat. I think it may, and I think it does. This, I say, is
the condition of things in perfect health, where the weight of the
body remains the same from day to day.

The food is consumed in giving this spirit, which is mani-
fested in animal heat, in organic movements, in the circulation
of the blood, in respiration, in muscular power, and in thought.
The organs by which the food is enabled to accomplish all this
are called glands, with the accessories which assist the glands in
their work, as the mouth, the stomach, the intestines, etc. In
the condition supposed, the food passes through the body without
adding one grain to its organized tissue, and without taking one
grain from it in the form of effete matter. But this condition

15

226 Cathartics,

does not often exist. In the variableness of human health there
is continual loss aud gain in the weight of the body. What I
maintain of that condition is this, that loss and gain never go on
at the same time.

We all know that individuals grow fatter and larger, and so
increase in weight; but that increase of weight is but an addition
of so much matter, which may again be removed without any
alteration or change in the original forms or organs. This
increase of weight is, of course, so much taken from the food,
leaving less to supply the manifestations of power and force, to
which I have alluded; and we know that most men lose in mus-
cular and intellectual power as they become large and fat.

There can not be a shadow of a doubt that both the liver and
the lungs effect important changes on the different kinds of food
as it passes through them. The food is made to pass through
these two glands before it enters the current of arterial blood;
and we can conceive of no reason for this passage, except that
some alteration or change has to be made in it.

The change effected in the liver I maintain to be this: The
absorbents or capillary vessels which take up the food from the
stomach and intestinal canal seem to have no choice or faculty
of choosing; for they take up medicines and poisons as readily
as they absorb the food. The liver acts upon all that is brought
from the stomach and intestines; it separates something from it:
what it separates is changed into bile. This is the first secretion
of bile. It is separated from the food by the glandular or cata-
lytic powers of the liver. This is the bile continually secreted,
and afterward emptied into the duodenum in a state of perfect
health. It is the bile which is secreted during growth from
infancy to manhood, while constructive assimilation is active.
It continues to be secreted and poured out into the intestinal
canal as long as food is eaten and digested. It is the bile thus
formed from the food, which commences to be poured out into the
duodenum within a very short time after a healthy meal; and
this kind of bile continues to be secreted and poured out as long
as any food is passing through the liver.

Cathartics. 227

This is the only rational explanation of the fact that the active
excretion of bile begins soon after digestion commences and con-
tinues while that process lasts. But whenever destructive meta-
morphosis is at work, and efiPete matter is separated from the
living organism and emptied into the veins by the capillaries,
then the liver acts upon the effete matter and forms it into bile.
Inasmuch as, while the glands are actively secreting, the venous
blood returning from them is nearly as red as the arterial blood
entering them, and as this is the case while the food is being
absorbed from the stomach and intestines, I think it is evident
that the bile-forming organs within the liver do not act upon
effete matter while the food is passing through it; but that they
act particularly upon it after the food has passed through the
liver.

As said in a former chapter, comparative anatomy shows that
the liver and lungs are compensatory or supplementary organs.
They could not be compensatory did they not separate something
from the food and blood, and unless the something separated was
excrementitious matter, to be thrown off from the body.

I have said that the kidneys perform an important part in
eliminating from the food elements or materials which they
change into the liquid and solid constituents of the urine ; that
they act upon effete matter in certain pathological conditions, I
also admit; but they act upon this effete matter as a heterogene-
ous mass, and form out of it urea and other substances.

I will not go over this again. The bile is an excretion, as the
urine is an excretion.

We have now to consider the bile formed from effete matter.
They deny the fact, and say that no bile is formed out of effete
matter. One of the substances found in the bile, as cho-
lesterin, they say, is found in other parts of the body, and there-
fore, according to their theory, it must be formed or made where
it is found. Dr. Flint says, volume 3, page 268, '' Cholesterin
is now recognized as a normal constituent of various of the
tissues and fluids of the body. Most authors state that it is
found in the bile, blood, liver, nervous tissues, crystalline

228 Cathartics.

lens, meconium, and fecal matter. We have found it in all
these situations, with the exception of feces, where it does
not exist normally, having been transformed into stercorin in
its passage down the intestinal canal."

I do not deny the fact that cholesterin may have been found
in the nervous tissues and in the crystalline lens; but I do
deny that it was ever found in a nerve or in the crystalline
lens of a perfectly healthy animal. Let physiologists look
back and state from what subjects the nerves and crystalline
lenses were taken in which they found cholesterin, and I will
venture to guess that they will have to admit that the subjects
were diseased ones.

It is formed in the liver, and whenever it is found in any
other part of the body, excepting the bile, it is because it is
carried along with the bile into the hepatic veins, and thus
finds its way into the general circulation.

We know that in jaundice the bile does not all pass into the
hepatic and cystic ducts, but that some of it escapes into the
hepatic veins. A part of the bile may thus escape without
being enough to cause discoloration of the skin and con-
junctiva.

Being a compound principle, it may be lodged in the tissue
of a nerve or in the crystalline lens, just as embolism occurs
in blood-vessels. Any other supposition would be to suppose
that the nerves and the crystalline lens have the glandular and
catalytic power to form proximate principles or compound
substances, which are no part of their healthy and perfect
organism.

Cholesterin is formed, as is every other proximate principle
found in the bile, by the glandular and catalytic power of the
liver, and it is formed out of effete matter.

It is, no doubt, impossible to separate the bile into two parts,
and to say that this part is formed out of the food and that part
is formed out of effete matter ; but the part formed out of effete
matter can only be formed out of effete blood, or when destruct-
ive metamorphosis is going on, and the body is losing in weight

Cathartics. 229

by a separation or throwing off of a part of its solid organism.
This condition, as I have before said, never occurs when con-
structive assimilation is in active operation. No physiologist
denies that effete matter^ so defined, must be taken up by the
capillaries, and that they empty it into the veins.

This compels me again to repeat that the capillary blood-
vessels have no glandular or catalytic power.

The blood is created out of the food by glandular action.
The excretions, for instance, those of the liver and kidneys, are
created out of the food and effete matter.

Physiologists, having adopted the theory of constructive and
destructive metamorphosis continually going on in animals in
health as in sickness, are compelled to find work for these two
processes to perform ; and as cholesterin and urea are sometimes
found in or near certain tissues, they are forced to conclude that
these two compound substances, as well as all other similar ones,
are produced in the organism or by the capillaries, which con-
vey the blood to them.

This conclusion leaves those wonderfully elaborate organs,
the liver and the kidneys, nothing to do but to remove com-
pound substances, such as are found in the blood and bile, from
the blood.

They can not say that all the other compound substances or
proximate principles found in the bile, except cholesterin, are
not removed in this way ; for when they say the bile is certainly
absorbed, and yet admit that they can not detect it in the portal
blood, they are estopped from denying that it may exist in the
blood, and that the liver only removes it as that organ removes
cholesterin and as the kidneys remove urea. If cholesterin and
urea were normal constituents of healthy organisms, as they
maintain, we would have blood-poisoning from the excess of
these compounds in the blood as a malady of constant occur-
rence ; for any derangement of the two processes of constructiv^e
and destructive metamorphosis might occasion an excess of these
deleterious principles, whereas uremic poisoning is fortunately
a disease of rare occurrence.

230 Cathartics.

I maintain that the liver forms or makes out of the food and
out of effete matter cholesterin and every other principle found
in the bile. I maintain also that the kidneys separate from the
food urea and every other constituent found in the urine ; and
that all the urea that the kidneys ever take up from the blood
is that which was first formed in them, and which passed into the
renal veins, because, for some cause, it was not emptied into the
ureters. I maintain that the kidneys do not act upon effete
matter at all when the animal is in good health; and, if at any
time they do act upon it, it is as a vicarious office — the liver,
perhaps, not performing its duties in removing effete matter
from the blood.

We know that the kidneys do act upon certain kinds of food,
as asparagus and the juices of watermelons, because we can detect
this by the odor, etc. Besides, there are many vegetable medical
substances which act as diuretics. These may be considered as a
part of the food. Moreover, there are many mineral salts, as
the bromide, iodide, and acetate of potash, which pass out of the
body directly through the kidneys.

Now all these medical substances are taken up from the
stomach or intestinal canal along with the food, and pass with
it, more or less directly, to the kidneys. By some law of nature
which we can not understand, all of the diuretics, both vegetable
and mineral, pass through the liver and lungs, as far as we can
tell, untouched, and go directly on to the kidneys, by which
organs they are removed.

I have said that the liver removes from the food certain parts
of it, which it forms into bile. Is it unreasonable to suppose
that other parts of the food, like the vegetable and mineral diu-
retics, go directly to the kidneys to be acted upon by them ?

We know that in the disease called diabetes mellitus, when
the liver fails to change the saccharine part of the food in its
passage through it, all of this saccharine matter passes directly
to the kidneys, and is removed by them.

This malady is very erroneously supposed to be a disease of
the kidneys, whereas it depends entirely upon the liver failing

Cathartics. 231

to perform one of its piost important functions — viz. the conver-
sion of every form of food containing sugar into something more
akin to blood. I do not deny that after the malady has contin-
ued for some time the kidneys themselves may become diseased,
because they have too much of this vicarious work to do.

It would be too much of a digression to say any thing more
here concerning diabetes mellitus. I only refer to it to give
another proof that the kidneys do act upon the food, and not
upon effete matter. This heterogeneous substance is only sepa-
rated from the living organism during sickness, or when the
body is losing in w^eight from any cause. It is all emptied by
the capillaries into the veins, and it is all carried, in my opinion,
directly to the liver by a law of animal economy like unto that
which carries diuretics to the kidneys. The bile, then, is formed
from the food and from effete matter.

We have next to inquire what becomes of it after it is poured
out into the intestines. The elaborate, voluminous, and learned
works of Drs. Flint and Dalton may be said to contain all that
is known of human physiology.

When I say that they teach, I, in effect, say that all physiolo-
gists teach that after the bile is poured out into the duodenum it
is absorbed, and goes back again into the circulation. Hence
it is, as they teach, a secretion and not an excretion, except the
cholesterin. Hence, with that exception, it is not formed from
or made out of effete matter. All physiologists agree that effete
matter has to be thrown out of the body as an excretion by some
channel or other; and as they deny that bile is formed out of
effete matter, they are forced to find some other channel for the
exit of this excrementitious substance. Thus it will be seen that
an erroneous theory as to the origin of bile compels physiologists
to select the kidneys as the organs by and through which effete
matter is removed from the living body.

If I can show that bile is an excrementitious substance or
fluid, then they must admit that it is formed from and out of
effete matter. When I enter upon this field of investigation they
must admit that I am standing upon terra incognita to them, for

232 (Jathartics.

having said that the bile is absorbed, they are precluded from
any reflections or criticisms on what I may discover, or on what
others may discover, or may have discovered.

In coming to the conclusion that the bile is absorbed, they
give as a reason for this conclusion the fact that the bile can not
be detected in the feces by chemical analysis. If the bile does
not enter into the composition of the feces, then it does not pass
out of the bowels through the rectum ; and then also we are shut
up to the unavoidable conclusion that the feces are composed
entirely of that part of the food which is not absorbed during
digestion, and of mucus and desquamated epithelial cells.

All observations made upon the stools before the discovery
that the bile is absorbed were erroneous ; and the observers, from
Hippocrates to the present day, who say that they saw or have
seen bile in the stools, were and are a set of nincompoops. I
believe that Galileo was once supposed to belong to that class of
mortals.

As the infant in utero swallows nothing, it has puzzled physi-
ologists to tell what the meconium is formed out of; and as cho-
lesterin is found in it, they have another difficulty. We who say
that the meconium, except a little mucus mixed with it, comes
from the liver and is made out of effete matter, are of course
nincompoops. Being such, and finding that the liver in the
fetus and in infants is excessive in volume compared with the
remainder of the body, we suppose that it is the organ which
eliminates effete matter from the blood and keeps it in a pure
condition; and we are strengthened in the position because we
find also in the fetus that the kidneys performed little or no
duties, there being very little if any urine in the bladder. Now
if the kidneys alone remove effete matter from the blood, if urea
is a constituent part of effete matter, being continually formed
by constructive and destructive metamorphosis from the moment
of conception, then we say that the fetus in every instance ought
to die of uremic poison, because the urea must remain in the
blood.

But if, as I maintain, the kidneys act exclusively upon the

Cathartics. 233

food and form urea and other compounds out of it by the gland-
ular and catalytic power of their wonderful organism, then urea
will never be found in the blood of a healthy fetus or of any in-
fant before it sucks.

If urea is at any time found in the urine of the fetus, it is
because the mother is not in a healthy condition, and there is
more or less urea floating in her blood.

If constructive and destructive metamorphosis are continually
going on in the body of a healthy growing animal, then there
must be, according to Dr. Dalton, over thirteen complete and
entire changes, and according to Dr. Thomas King Chambers
over six such changes during fetal life of two hundred and sev-
enty days.

If such a law exists in the animal economy, it is a constant
law, and operates as certainly during fetal life as it does in the
development and growth of the tiniest radiate, mollusk, or artic-
ulate.

Now I ask what becomes of the effete matter so separated
during fetal life? Any answer would involve an absurdity as
manifest as the reductio ad absurdum in any geometrical problem.
But if, as I maintain, destructive metamorphosis never operates
during healthy growth, then we might expect to find what we do
find — viz. a very small amount of meconium in the bowels of a
new-born infant. This small amount may be produced, and no
doubt is produced, by the variableness in the health of fetal
bodies; which allows that law to act as it does in healthy grown
people whose' bodies occasionally change in weight. But it may
also be produced by the liver acting upon blood which may be
said to be effete. In either case the meconium is formed by the
liver, and is the first form of bile.

To return again to the feces. If they are composed entirely
of that part of the food which is not absorbed, and of mucus
and desquamated epithelial cells, then it would be difficult, if not
impossible, to account for the large amount of fecal matter which
is discharged from the bowels by many individuals in health as
in sickness; for we know that some kinds of food, as milk and

234 Cathartics.

nutritious soups, not to name many other forms, are about all
absorbed. During the sickness of many persons we often no-
tice large fecal discharges when patients have eaten little or no
food for several days.

If the liver pours out two pounds and one half of bile daily
into the duodenum, we can easily account for the large amount
of feces discharged during this abstinence from food.

This is upon the supposition, which I maintain to be a fact,
that the bile enters into the composition of the feces and is
formed, in sickness, out of effete matter. I know for a certainty
that such discharges do occur during sickness when the patient
eats little or no food ; and I know also that such discharges fol-
low the administration of medicines which excite the liver to the
formation and pouring out of bile.

Physiologists say that cholesterin does not enter into the com-
position of the feces as cholesterin, but is changed into stercorin,
and forms a part of the feces under that form. If the choles-
terin may be changed in form, I ask how do they know that the
other constituents of the bile may not also be changed so as to
prevent them from being able to detect these constituents of the
bile in the feces?

Going back, no doubt, to the days of Hippocrates, all medical
observers have witnessed that healthy feces have free properties
or qualities peculiar to theiji — viz. the odor, the color, and the
consistency.

These qualities or properties are necessary parts of the com-
position of feces. Whenever the feces are deficient in any one
of these qualities or properties, then they are recognized as
unhealthy by all medical observers who think as I do. Of
course we are supposed to be nincompoops by that highly
respectable class of gentlemen who assume to be scientific phy-
sicians; but we number on our list a vast multitude, among
whom are many names supposed to be immortal.

It is constantly observed that the feces are ashy or clay-col-
ored, and the individual discharging such is dyspeptic or other-
wise sick. If we give such a patient calomel or some other

Cathartics. 235

medicine which acts upon the liver, we notice that the feces
become dark in color, or more consistent, and have the odor
peculiar to them. I say this is because the liver has been made
to act. The same remark may be made to apply to a hundred
forms of indisposition or ill health.

I have already alluded to the remarkable fact, that physiolo-
gists have not taken into account the very large amount of excre-
mentitious effete matter which escapes from the bowels in the
form of gas. If I assert that cholesterin passes off with the gases,
who is prepared to deny that I am correct? The same thing
may be true as to the disposition in part of other constituents of
the bile. It is no doubt true as to the disposition of a large
amount of fecal matter by many individuals. They are the per-
sons who go for days, and sometimes for several weeks, without
discharging fecal matter from the bowels. We know that in
such cases when there is an operation or alvine discharge, it is
in the form of hard balls called scybala. In these instances the
fluid part of the feces has escaped with the gases.

Assuming, as I do, that constructive and destructive metamor-
phoses do not go on at the same time in a living animal, then it
follows that the only source of bile, when constructive assimila-
tion is active in the animal body, is the food passing through the
liver.

In this condition of health the constant flow of a large amount
of bile must be from the food. So far as humanity is concerned,
there is no secretion and excretion on the regular and healthful
performance of which mens sana in eorpore sano so much depends
as on the constant and uninterrupted secretion and pouring put
of healthy bile.

Knowing, as we do, that a very large amount of food passes
directly from the stomach and intestines to the liver, is it not,
among all things, reasonable to suppose that the liver acts upon
the food as it passes through it? And are we not strengthened
in this conviction because we know that bile begins to be poured
out freely immediately after the food begins to be absorbed ? If
I am correct, the liver separates from the food such parts as

236 Cathartics,

ought to be separated, and pours them out in the form of bile
into the duodenum. Bile derived from such a source must of
course be excrementitious, and it has to pass out of the bowels
with the gases which escape from them or as a component part
of the feces. But if again destructive metamorphosis is working
when constructive assimilation ceases to act, then the only source
of bile will be the effete matter separated from the living or-
ganism.

If the individual under consideration takes some nourish-
ment, of course the liver will separate, or attempt to separate, the
form of bile above spoken of from it. This labor should not be
thrown upon the liver and other glands during the continuance
of maladies in which destructive metamorphosis is active.

There can not be any greater error in the practice of medi-
cine than to compel patients, laboring under acute diseases, to
swallow large quantities of food daily, under the notion that
this food goes to supply the place in the living organism of the
effete matter removed by destructive metamorphosis ; or, as Dr.
Chambers expresses it, ^'to put in a new brick where an old one
has been taken out/' Dr. Chambers admits that hospital pa-
tients do much better under this system of treatment than do
patients in the higher circles of society.

It is, perhaps, because the food furnished in the hospitals
is so much better, more nutritious and digestible than that
which the hospital patients were accustomed to, that it acts as
a healthful stimulus, enabling the liver and all other glands
engaged in digestion to perform their work more easily. But
this is a digression.

When destructive metamorphosis is in operation, very little
food is ordinarily consumed, and a large amount of effete mat-
ter is continually thrown off from the body. This is evidenced
by the daily loss of weight in individuals. Now, according to
the teaching of all physiologists, this effete matter is removed
from the blood by the kidneys. This assumption is in the face
of the well-known fact that during many forms of sickness, in
which there is great loss of weight, there is very little urine

Cathartics. 237

poured out by the kidneys into the bladder; certainly not
enough, nor any thing like enough, to account for the amount
of effete matter separated from the living organism by destruc-
tive metamorphosis.

All physiologists and all physicians know, that unless the
effete matter so separated is eliminated from the body it will
aggravate the malady, leaving little or no chance for the pa-
tient to recover. Death from uremic poisoning is one of the
results of the retention of one of the forms of effete matter
in the blood.

The retention of any form of it is more or less deleterious.
Now I m&intain, as up to a very recent time all physiologists
maintained, that the liver removes the effete matter from the
blood ; and I affirm, as they affirmed, that the well-being or
improvement of a patient depends more upon the liver regu-
larly removing the effete matter than upon any other one of
the organic functions.

It is thus again that I show that bile is an excrementitious
substance, which either passes out in combination with the feces
or escapes from the bowels with the gases. The bile, then, being
formed from the food and effete matter, it follows necessarily
that if only a small quantity is eaten, but little bile can be
formed from the food ; and if the body is losing but little in
weight, then only a small quantity of bile can be formed out of
effete matter, for the quantity of bile derived from that source
depends entirely upon the amount of effete matter separated
from the living organism by destructive metamorphosis.

This is a very important consideration in the practice of
medicine, for the physician ought not to expect to see much
bile passing from the bowels when the patient is "feating very
little, and when the daily loss of weight by the body is but
a few ounces. It is a very common error among the people
to suppose that the bile is a morbid or unhealthy excretion.
It is in fact one of the most healthy and regular of all the
visible products of organic life. This is evidenced by the
color, consistence, and odor of natural, healthy feces, so well

238 Cathartics,

known by the commonest observers among all races of men.
To understand fully the importance of a careful examination
of the stools at the bed-side, we must first acquaint ourselves
correctly as to what constitutes healthy feces.

The views which I am here presenting as to the functions of
the liver, and as to the bile being formed out of effete matter,
and bile being an excrementitious substance, were particularly
inculcated in the medical department of Transylvania University.
Benjamin Winslow Dudley, M. D., Charles Caldwell, M. D., John
Estin Cooke, M. D., and James Conquest Cross, M. D., all agreed
as to the truth of the principles which I am here advocating.
Dr. Dudley's lectures made a profound and lasting impression
upon the large classes which heard him for years ; but he has left
very little in book-form.

Drs. Caldwell and Cooke were voluminous writers. I have
quoted largely from Dr. Cooke's book. My friend Dr. Elisha
Bartlett said to me that he considered CaldwelPs Notes on
Cullen's First Lines among the most philosophical writings he
had ever read. Dr. Cross, as a writer, confined himself to essays.
It is to these that I am about to refer. Dr. Cross may be said
to have been a disciple of Dudley, Caldwell, and Cooke, and he
expresses in these essays what he may be said to have adopted
from each of them. The essays referred to were published in
the Western and Southern Medical Kecorder, 1842, of which Dr.
Cross was the editor, and of which I was for a time assistant
editor.

It is because I believe this whole subject to be so little under-
stood that I make these references. It is inexplicable to me how
the learning of the past has come of late years to be considered
as nonsense.'

The first medical writers in this country and in Europe may
be said to ignore entirely the uses of the bile, which they admit
when they declare that it is reabsorbed.

We copy from Dr. Cross's article entitled "Thoughts on the
Biliary Secretion": ''In regard to the vessels which enter and
those which come out of the liver, there is a striking peculiarity

Cathartics, 239

that should be particularly noticed, which is that the former are
larger than the latter, and circulate more blood. This is not the
case in regard to the other organs ; those that return the blood
from them are always larger than those that carry it to them.
This is an important anatomical peculiarity, and it will assist in
understanding the facility with which, under certain circum-
stances, the liver becomes diseased."

He states the following propositions, to which we shall allude
as far as it will be necessary :

First. The blood of the arteries is different from that of the
veins.

Second. The blood of the vena portarum and its tributaries
is different from that found in the other veins.

Third. The elements of the bile are found chiefly, if not
exclusively, in the portal blood.

Fourth. Portal blood is different from that found in the
hepatic veins.

Fifth. Bile is less vital than recrementitial secretions.

Sixth. Bile is not concerned in the process of chylification.

Seventh. The peristaltic action of the bowels is in no way
dependent on bile.

Eighth. Bile is an excretion of the liver, consequently a dep-
uratory organ.

Many of the questions discussed on these eight propositions I
have already considered in former chapters. Dr. Cross assumes,
as an undisputed fact, that the bile is formed from effete matter.
I agree with him and with all other physiologists in this, that
effete matter is separated from the living organisms by destruct-
ive metamorphosis, while I affirm that destructive metamorpho-
sis only takes place when the body is losing in weight.

Dr. Cross says on the third proposition, '' If bile is formed of
effete matter; if this imparts peculiarities to portal blood, by
which we are enabled to distinguish it from other blood; if the
liver is a depuratory organ, and causes portal blood to part with
some of its distinctive attributes during its transit through that
organ, it is altogether probable that in passing through it, portal

240 Cathartics.

blood experiences such a change as to enable us to distinguish it
from that which is found in the vena cava, and which consists in
great part of blood that has circulated through the liver. If, in
other words, the liver, like the lungs, purifies the blood from
injurious matters with which it is incorporated, we should see, as
in the blood which returns from the latter to the heart, some
evidence of it in the blood that returns from the former to the
vena cava. That such is the fact, the proposition which we have
just been considering seems very clearly to indicate. We have
no reason to believe that caval differs from venous blood in gen-
eral, and as it has been shown that there is obviously a differ-
ence between the latter and portal blood, it follows as a neces-
sary consequence that portal blood and caval blood are not per-
fectly identical. One of the principal points in which portal
blood and that of the other veins differs, is in respect to color;
the former is said by many observers to be of much darker hue,
and to contain, according to the doctrine for which we contend,
a larger amount of effete or refuse matter. If this contains the
elements of bile, and the dark color of portal blood is owing to
its presence in it, it is evident, as the bile is separated from the
blood in its passage through the liver, the blood must become of
a less dark hue."

"That the blood of the vena portse in circulating through
the liver is exposed to a process of depuration, something like
that exerted upon the blood in its passage through the lungs,
can not be considered improbable. And, moreover, when we
recollect the disparity that subsists between the size of the ves-
sels that enter and those that come out of the liver, it must be
very sensibly strengthened. The former are larger than the
latter, doubtless because more blood enters that organ by the
vena portse and hepatic artery than returns to the general cir-
culation through the hepatic veins, and consequently there must
be some other outlet ; and we know of no other than that fur-
nished by the biliary ducts through which the effete matter or
bile passes into the bowels. If the office of the liver, in common
with that of the lungs, is to purify the blood of its refuse mat-

Cathartics, 241

ter, it may be asked why does not the blood, in passing through
the liver, experience a more remarkable change — why is it not
as obvious as that which takes place in the lungs? To this
question we would respond, that the wonder is not that the
change experienced is not greater, but that it is so great. The
blood of the vena portse, after having furnished the elements of
bile, and that of the hepatic artery, after having yielded nourish-
ment to the liver, are received into the capillary ramifications
of the hepatic veins, into which is also emptied the effete matter
of the liver, which circumstance is, of itself, nearly sufficient
to counteract any depurating action which may be exerted upon
it by the liver. Besides, the liver and the lungs are differently
situated. In the former the blood is merely decarbonized, but
in the latter it is decarbonized and receives oxygen from the air;
in the former the blood that has been decarbonized is immedi-
ately mixed with the refuse matter of the liver, but in the latter
the decarbonized blood is not again mixed with the refuse matter
until it reaches the general system, for the effete matter of the
lungs passes into the capillaries interposed between the bronchial
arteries and veins, and then the blood is allowed to return to the
left side of the heart, purified in a great degree from refuse
matter by the joint agency of the liver and lungs.''

On proposition fourth he says, " There are but two organs in
the animal economy to which two kinds of blood are sent. They
are the lungs and the liver; and in regard to the former, it is
evident that one kind would not be sufficient to enable them to .
perform the functions that are dependent upon them. Blood is
sent to them for the purpose of being arterialized, and blood of
a different character to nourish them. One kind to be freed
from its impurities, and another kind already in a state which
fits it to maintain the physical structure of the organs."

Now the object of this arrangement of the vascular systems
of the lungs is perfectly intelligible, and yet it is not in any
respect different from the vascular systems of the liver.

Two kinds of blood are sent to the liver for precisely the
same purpose that they are sent to the lungs.

16

242 Cathartics.

That through the vena portse to furnish bile, and thus free
the blood from effete matter; and that through the hepatic
artery to nourish that organ.

The nourishment of the liver can not be ascribed to portal
blood, for that would be wholly inconsistent with a fundamental
principle of nutrition, which is that the nourishing fluid must
be always furnished by arterial blood. The small size of the
hepatic artery is of itself sufficient to refute the idea that its
blood yields nourishment to the liver and also the elements of
biliary secretion.

On the fifth proposition Dr. Cross says, "... And then,
bile in the gall-bladder is certainly a very different fluid from
the secretion that is found in the biliary ducts. In that reservoir
it is found to possess properties very unlike those by which it is
characterized just after it is separated from the blood. In the
biliary receptacle, when it has been confined there for a consid-
erable length of time, it is observed to be a green and sometimes
of a black color — to have a very bitter taste, and offensive
smell, a viscid consistence, frequently concreting, sometimes
being converted into calculi, and apparently of a very hetero-
geneous composition ; while that which is found in the biliary
ducts is a thin, yellow, sweetish, inodorous, and, in some degree,
a homogeneous fluid.'^ He says, "In inanition bile is rapidly
and in great abundance formed, and it becomes under such cir-
cumstances very bitter."

Bile formed under such circumstances must of course be
formed entirely from effete matter.

" A sudden augmentation of bile, says Dumas, is an invari-
able consequence of those emaciations in which the fat rapidly
disappears, and this is so uniformly and obviously the case that
Thornell says that the liver eats the fat.''

" By Lorry, Thornell, Fourcroy. Dumas^ and many others, a
great similitude has been remarked between fat and bile. From
those observers we learn, what experience has taught every atten-
tive physician, that they exist in an inverse ratio; that when
the deposition of fat becomes great and obesity is the result the

Cathartics, 24S

biliary secretion diminishes; and that when the fat is being
removed by intestinal absorption, and emaciation produced, the
afflux of bile into the bowels is rapid and abundant. They
also remarked that the bile that flows during the decline of
excessive embonpoint is of a degenerative character. It is the
result of a very frequent, diversified, and abundant experience,
that those cases of fever that do not emaciate, are very obstinate
and difficult of cure. Now my attention has been particularly
directed to such cases, and I assert from actual observation that
the liver is always in a torpid state; that no improvement
ever takes place until the liver is provoked to act, and then
emaciation follows.'' .... "Now when we have in mind the
multitudinous and discrepant sources from which the vena portse
receives its supplies, we can not be surprised that its contents
should vary considerably in character, or that portal blood should
yield a secretion very complex and heterogeneous in its constitu-
tion and nature."

On the sixth propsition, Dr. Cross says, " If bile is formed
of effete matter, which has been removed from the textures
because of its unfitness to sustain their physical structure, it
is absurd to allege that it is necessary to the proper assimila-
tion of the nourishing fluid that has just been extracted from
the contents of the stomach.''

As to the bile mixing with the food after it passes into the
duodenum, Dr. Cross says, "By Hunter it is said it does not ap-
pear that there takes place an admixture between the bile and
the digested aliment. The former passes over the latter, never
incorporates with it, and is expelled from the bowels in conjunc-
tion with the excrementitious part." This is the opinion of
Abernethy. He remarks that bile does not incorporate with
the digested aliment, "because the least quantity of bile will
give taste and tinge to a very large quantity of other matter."

It had never occurred to Dr. Cross that the clear, sweet,
inodorous bile was formed from the food, while the dark, viscid,
offensive bile was formed from effete matter. I think I have
clearly and conclusively shown the different sources of these two

244 Cathartics.

kinds of bile. Modern physiologists agree neither with Dr.
Cross nor myself.

"Dr. Cross says, ''The particular terminus of the chole-
dochus duct in most animals has been urged to prove that the
bile is necessary to convert chyme into chyle. It should, how-
ever, be recollected that in some animals bile is not poured into
the duodenum. In some of the molluscous animals the small
bowels receive but a very small portion of the biliary secretion,
and that too not at their upper but at their lower portion. The
greater part of the bile is emptied either into the cecum, or very
near the anus, at points very remote from the seat of chylifica-
tion. In such animals bile is very evidently an excretion.''

Dr. Cross concludes with the following remarks : " Without
indulging in numerous details, we shall merely draw attention to
a fact which is admitted by all, which is that diseases of the
lungs are most common in high northern climates, while those
of the liver prevail almost exclusively in low southern latitudes.
The pulmonary and hepatic apparatuses are the two leading
emunctories of the system, and are placed at the extremities of
the venous circulation, where it is presumable such matters as
should be excreted are accumulated in the greatest abundance.
Now the excretory function of the skin is closely associated with
the functions of both of those internal excretory organs, so
much so indeed that a change in one for the better or the worse
can not take place without being felt to a greater or less extent by
the others. Thus if cuticular action is energetic, there will be an
abundant hepatic secretion, but a sparing pulmonary exhalation ;
if cuticular action is enfeebled, there will be a languid secretion
of bile, and a determination of fluids to the lungs; if there is
diminished action of the hepatic, there will be increased action of
the respiratory apparatus, and vice versa.

" External temperature is the most powerful known cause of
these various modifications. When it is high, the skin and liver
act freely, and then a diminished amount of excretory duty de-
volves on the lungs ; but when it is much reduced, the functions
of the former are languid, while that of the latter is energetic.

Cathartics, 245

Overexertion of any organ is a common cause of subsequent
enfeebled and often suspended action, and consequently of dis-
ease. Thus in cold climates, from the moderate functional exer-
tion of the skin and liver, the principal excretory duty falls on
the lungs, and hence the frequency of pulmonary complaints in
northern regions ; but in tropical climates this labor falls on the
liver, and hence the frequent and fatal abdominal diseases so
characteristic of southern latitudes. In temperate climates, such,
for example, as that of Kentucky and most of the Middle States,
the blood is freed from its impurities in about an equal degree
by the liver and lungs, and consequently we have rarely either
the pure liver- or lung-diseases so common in northern or south-
ern latitudes.

" Both the hepatic and pulmonary elements are distinctly ob-
servable in a great majority of the cases of disease that occur, and
the physician who does not keep these facts continually in mind,
or is too exclusive in his pathology or therapeutics, will surely
find to his cost that he has misapprehended the character of the
enemy with which he has to contend."

It has been ascertained that, as a general rule, those animals
in which there is an extensive respiratory apparatus have a small
biliary organ, and vice versa.

Then by Dr. Carpenter we are told that "Among the insect
tribes the liver is but little developed, and it would seem that it
is altogether subordinate to the urinary system, which has been
erroneously considered a part of it. It is easy to account for the
low condition of the liver in these classes ; since the extensive
amount of the respiratory function must render almost unneces-
sary any other method of discharging carbon from the system.
It is not among all the articulata, however, th^t the liver appears
a subordinate organ; for in the Crustacea, whose respiration is
aquatic, and therefore less energetic, it attains a very consider-
able size, occupying frequently a very large part of the abdomen,
and in one or two species acquiring a spongy texture by the
union of its minute subdivisions into one mass, so as to resemble
in some degree the solid form which this gland presents in higher

246 Cathartics.

animals. The liver usually presents in the mollusca a very large
size and highly-developed condition, which may be fairly regarded
as compensating for their feeble respiratory powers. The liver
is of a reduced size in birds, but this apparent deficiency is not
felt by them, as the respiratory apparatus presents an uncom-
monly extensive development. Between the liver and the lungs
of the mammalia we do not observe that remarkable dispropor-
tion which seems to be characteristic of most of the inferior
orders of animals; they are of medium size and in proportion
to the bulk of the animal in which they are found. The depu-
ration of the blood therefore, under ordinary circumstances, is
devolved neither mainly nor exclusively upon the one or the
other — it is the result of their joint agency, neither of them
ever performing extraordinary duty, except from the force of
known causes, and then disease is very apt to follow.'^

Dr. Cross's remarks in the essays from which I have quoted
apply principally to the formation of bile in the bodies of the
sick. He taught, as I do, that eiFete matter is then separated
from the solid organism; and we both agree that this effete mat-
ter is separated from the blood by the liver and lungs.

Dr. Cross has referred to the fact that in some of the severest
and most fatal forms of fever there is no emaciation or loss of
weight, and that no improvement in such cases is manifest until
emaciation or loss of weight begins, which is always attended by
a free pouring out of bile.

Dr. Benjamin Rush speaks of a similar form of fever in
which there was no disturbance apparent in the regularity of the
heart's action and when the temperature of the body remained
natural. In such cases destructive metamorphosis is going on,
and effete matter is separated from the living organism ; but if it
is not thrown out of the body by some gland, there will of course
be very little loss of weight ; only so much as is carried off by
perspiration and by respiration.

Here again we find another proof that the kidneys do not
remove the effete matter from the blood. Every physiologist
knows, and no one of them will dispute the fact, that all gland u-

Cathartics, 247

lar secretion is suspended during the exacerbation of fevers. It
is a fact also equally well known to them, that during the con-
tinuance of a fever, there is a free or increased flow of arterial
blood during that stage of fever, and during that only, which is
called the stage of excitement or reaction, in contradistinction to
the access, the chilly or cold stage, and the sweating stage. Now
during all these stages, except the one of excitement or reaction,
there is weakened action of the heart. This weakened action
necessarily involves and produces congestion, more particularly of
the abdominal viscera. Weakened action of the heart, with its
concomitant congestions, necessarily involves a diminished flow
of arterial blood ; so that it would be only during the stage of
febrile reaction that any large or even regular quantity of arte-
rial blood would be sent to the kidneys. But it is during this
stage, as I have said above, that no secretion or excretion takes
place in the glands. No effete matter then could be removed
from the blood by the kidneys during the stage of reaction, when
there is an increased flow of arterial blood through them. Now
bear in mind that in fevers where there is emaciation there must
be a large amount of effete matter separated from the organism.
During which stage of the fever, I then ask, do the kidneys
remove it from the blood? I have shown that during one of the
stages they can not remove it, because no glands either secrete or
excrete during the stage of febrile excitement. Perspiration
even is suspended at the time. I have also shown that during
the other three stages there is a diminished flow of arterial blood
to the kidneys as well as to the other organs. The liver, as a
gland, is subject to the same law. But there is this remarkable
difference between the liver and the kidneys: during all the
stages of fever in which there is weakened action of the heart,
with the attendant and unavoidable congestions, there is an
increased volume of blood within the cavities, and particularly
in the veins which carry blood to the liver. The more com-
pletely the action of the heart is weakened and the greater the
congestion in the abdominal veins, the larger is the amount of
blood which is pressing upon the liver for transit through it.

248 Cathartics.

Dr. Cross says — which I know to be the fact — that apparent
improvement begins in the cases to which he referred so soon as
there is a free flow of bile. This I maintain, as he does, is
because the liver separates the effete matter from the blood and'
pours it out as bile into the bowels.

This is the formation of bile out of effete matter. Healthy-
reaction, not febrile excitement follows this exit of bile from
the body. Now during all this time very little urine is sepa-
rated from the blood by the kidneys and poured out into the
bladder; not enough certainly to account for the loss of effete
matter, when there is great emaciation.

Dr. Cross says there is no improvement in fever cases until
the patient begins to emaciate or lose in weight, and that during
that condition the action of the liver is suspended. Such a state
of things may, and often does, exist. Thousands and tens of
thousands of individuals die annually because the liver is not
made to separate the effete matter from the blood — which is
a poison in and of itself — and to pour it out into the bowels
in the form of bile. That the liver can be made to secrete bile
and to pour it out I will show in another chapter. I now refer
to the action of cathartics, and particularly of calomel. I have
shown in the preceding chapter that it can be done by emetics.

It can not be too constantly borne in mind that destructive
metamorphosis never goes on in the human body, and that con-
sequently effete matter is never separated from the living or-
ganism, except when there is a disturbance in the functions of
organic life. It is always a pathological condition, and its re-
moval from the body involves an increased labor of some organ.
As I have before said, the natural and healthy function of the
liver, in a state of perfect health, is to remove certain constit-
uents of the food which ought to be separated from it, and to
pour them out as bile into the bowels. Whenever, then, the
liver has to create bile out of effete matter, it is extra work
thrown upon it. The existence at all of effete matter in the
blood is a thing pernicious in itself. Ordinarily it is known
by the commonest observers of hygienic rules. The liver

Cathartics, 249

will go on to do this work without the individual knowing
that he has a liver ; but if, to the difficulty of the existence
of effete matter in the blood, there is added a fever poison, such
as malaria, then the trouble is increased. The healthful action
of the liver, as of all other glands, depends upon a due and
regular supply of pure arterial blood. Any fever poison, or
proximate cause of disease, produces a disturbance in the entire
system of organic life. The liver feels this disturbance as well
as any other organ, and as it has extra work to do when it is thus
incapacitated, it often has to be stimulated or forced to perform
the labor thrown upon it. When the limbs complained of the
belly, in ^sop^s fable, they did not know that if one of the
organs in the belly (the liver) did not work they would all soon
be dead.

If bile, then, is formed from effete matter, and if effete mat-
ter is never separated from the living organism, except when
the individual is indisposed or sick, it must be apparent to
every one who will reflect, that there is no gland in the body,
upon the regular performance of whose functions good health
so much depends.

I will request the reader again to examine and to consider
what I have copied from Dr. Cooke on congestion. The mul-
titudinous complications in all forms of sickness resulting from
congestion within the cavities, and particularly of the abdomi-
nal viscera, can only be relieved by the removal of effete mat-
ter from the blood. It is the especial duty of the liver, under
such circumstances, to do this work. Cathartic medicines ac-
complish very little unless they contribute to this end.

The removal of the feces from the bowels, considered simply
as the removal of what remains of the food, is perhaps the
smallest part of the service performed by them when judiciously
prescribed. But there are many other pathological conditions in
which there is no very apparent disturbance of the regularity of
the hearths action, and in which there is no obvious congestion in
the veins of the abdominal viscera, yet becsiuse the liver fails to
remove the effete matter as fast as it is separated from the living

250 Cathartics.

organism, there occur irregularities in other organs, so that they
do not perform their proper functions. This often amounts to
what may be called a disease.

I will give an instance. It often happens that there is some
trouble in the urino-genital system. The remote cause may be a
lesion, as, for instance, stricture in the urethra, or enlargement of
the prostate glands. Now some persons will go for many years
without any particular trouble on account of their lesion, but a
time comes when the lesions cause an obstruction in the passage
of water from the bladder. Sometimes it is impossible to remove
this water by the catheter. It will be found that medicines which
are supposed to act specifically upon the bladder or any part of
the urinary system only arggravate the evil when they are admin-
istered. In such cases if the liver is roused to action and made
to secrete or pour out bile freely the whole difficulty will be
promptly and often entirely removed. This is altogether in
accordance with the doctrines which I am so earnestly endeav-
oring to teach. There is one condition in which it may be said
that constructive and destructive metamorphoses do go on at the
same time when the animal is in good health. I allude to the
training of a race-horse or an athlete. The exercise and other
training cause the animal to throw off fat, and what is com-
monly called cellular substance. Of course these are removed
from the body as effete matter. On the other hand, the muscles
are more fully develoned, and the animal becomes stronger and
more active. I do not think this training can be called a state
of perfect health.

In my assertion that effete matter is not separated from the
living organism when the animal is in perfect health, I am con-
sidering both constructive and destructive metamorphosis sjmply
as organic or vegetative functions. Neither the horse nor the
man would lose in weight — that is, have the effete matter thrown
off — unless the organic or vegetative functions were brought under
and subjected to the control of the organs of animal life. But
it can not be made to appear that the muscles increase in size
and grow stronger until after the fat and cellular substance have

Cathartics. 251

been removed. We know that there is one condition in which
only one of these processes can go on. When either a well or
sick man is losing weight daily without eating any thing, con-
structive metamorphosis is certainly not acting. No physiologist
can deny this.

Now if it can be shown, as this case certainly shows, that
destructive metamorphosis can go on, and does go on alone, and
is a single force, is it not incumbent upon physiologists to show
that such is not the fact? Look at the vegetable world. Is
there a single instance in which construction and destruction go
on in the same body at the same time? Consider the world of
plants. Take the seed of the cucumber. It sprouts. It forms
a vine and blossoms. After a few days we have a full-grown
cucumber. The whole plant, including the fruit, has fashioned
the sustenance or food which it drew from the inorganic world
into a luxuriant vine and cucumbers. During its growth the
plant throws off carbonic acid, but thaHwas not a part of its
living organized tissue. It was one continual growth, one con-
tinual exercise of the force of constructive assimilation. But
after a while things change. The leaves begin to wither, the
cucumbers turn yellow, and in a few weeks or months all rot
and return again to the inorganic world. Thus destructive meta-
morphosis, and it alone, is operating upon the plant. If this
law exists in plants, it exists also in animals. No physiologist
will deny this.

It is because organic life in man is so much under the control
of the functions of animal and intellectual or mental life, that we
find it almost impossible to say when constructive assimilation
ceases, and destructive metamorphosis, or the separation of effete
matter, begins. They do not go on with the regularity of ebb-
and floodtide; but like the tides, the one force must cease to
move before the other force begins.

In a former chapter I have clearly stated that when construct-
ive assimilation is alone active, and there is no separation of
effete matter from the tissues, the liver and other glands may and
do act upon effete blood. But this applies more particularly to

252 Cathartics.

grown individuals who do not increase in weight when the food
passes through the system without adding any thing to the mate-
rial organism.

Dr. Dudley adopted the practice of Mr. Abernethy in the
treatment of diseases generally, and that of John Hunter in the
treatment of certain maladies. He did not trouble himself much
with physiological or pathological considerations. He agreed,
however, with Dr. Caldwell, who was more speculative, that the
secretions and excretions should always be considered and
attended to. Dr. Cross considered Dr. Cooke to be the Magnus
Apollo of the medical profession, though he did not follow his
practice.

It was the enormous quantities of cathartic medicines given
by Dr. Cooke which brought both his theory and practice into
disrepute. When Dr. Cooke was examining the writer — in the
greenroom — ^he told the learned professor that he did not agree
with him as to his practice. The exclusive use of cathartics is
not a necessary corollary from Dr. Cooke's theory of congestion
and of the functions of the liver. I think the medical world
would be benefited by a republication of his two books. Dr,
Caldwell's great work was his essay on " The Temperaments."

Coiomel. 253

CHAPTER XIII.

Calomel.

Calomel is classed among cathartic medicines. Before we
inquire into its uses as a therapeutic agent, we must inform
ourselves as to what we expect to accomplish by any medicine
belonging to this class. I have before shown, in the chapter
on Emetics, that the vomiting up of undigested food remaining
in the stomach is among the least of the benefits to be expected
from medicinal emesis ; and I would now state that the removal
of the debris of the food from the bowels is among the smallest
benefits to be expected from a cathartic judiciously prescribed.
For such a purpose calomel should never be used. There are
some diseases, as dropsy, in which it may be desirable to excite
the pouring out of the serum into the bowels ; but there is no
disease with which I am acquainted in which any therapeutical
benefit is to be expected by the pouring out into the bowels of
more than a natural quantity of mucus.

Many cathartics excite a greater flow of mucus than,, that
which covers the internal coat of the bowels in health. But
while this is sometimes inseparable from the action of cathar-
tics, it is in no case desirable. If nothing more is to be ex-
pected from the action of cathartics than the removal of mucus
and desquamated epithelial cells, then castor oil is the best of all
cathartics, and I know of no reason why any other medicine of
that class should ever be given. We might, instead, rely on the
lavements of the French, or injections or clysters of the English.

254 Calomel,

The one or the other will accomplish all that can be effected by
a cathartic, if the removal of the substances spoken of is all that
is to be accomplished. Until recently it was supposed that
cathartic medicines excite the liver to pour out bile freely into
the bowels. Before the discovery of calomel, aloes and rhu-
barb were among the medicines used by the ancient physicians
with this end in view.

The Greeks and the Romans speak of seeing black, green,
and yellow bile in stools, and state that they followed the admin-
istration of certain medicines. Physicians, from their day to
the present, have said the same thing without there being any
mental reservation or conception that what they said was not
true. But things have changed, and v^hat a change !

A few years ago a committee of physicians was appointed in
Edinburgh to determine the fact whether calomel or any other
medicine excited or stimulated the liver to secrete and pour out
bile. They made numerous experiments on dogs, and perhaps
some other animals. The conclusion at which this committee
arrived is expressed by Sydney Ringer, M. D., of London, as
follows :

"First. That neither blue-pill, calomel, nor corrosive subli-
mate affect the liver unless they purge or impair the health,
when the quantity of bile is diminished."

"Second. Purgation from any cause lessens the amount of
bile and the proportion of its constituents.''

It is said also by this committee that doses of podophyllin,
varying from two to eight grains, diminished the solid constit-
uents of the bile, whether they produced purgation or not, and
that doses that produced purgation lessened both the fluid and
solid constituents of the bile.

Dr. J. Hughes Bennett was the chairman of that committee.
No report made by a committee of physicians ever made a more
decided impression upon the medical world than has the one of
which Dr. J. Hughes Bennett is the author.

Job said, "O, that mine enemy had written a book." I
do not consider Dr. Bennett to be my enemy, but I class

Calomel, 255

him among hostes humani generiSy and therefore rejoice that he
has written a book. I copy from his book entitled Clinical
Lectures on the Practice of Medicine, to show what he sup-
poses has been accomplished by the medical profession as to
the therapeutical value of medicines.

"First, then, are there many drugs or medical preparations
whose effects are unquestionably beneficial in particular diseases?
I think there are, as witnessed by the influence of, first, quinine
in ague; second, pitch ointment in psoriasis; third, male shield-
fern in tapeworm ; and fourth, sulphur ointment in scabies.

" I think no one who has used these remedies in the diseases
named can doubt their curative power as a matter of fact, how-
ever they may differ as to the mode of their action. Of a simi-
lar unquestionable character are the following, although, for the
reasons previously stated, the first two should be placed among
the dietetica, and the third among the hygienica. They are,
fifth, cod-liver oil in scrofulous and tubercular diseases; sixth,
lemon-juice in scurvy ; and seventh, constant moisture in eczema-
tous and impetiginous diseases of the skin.

" These seven remedies I put into the first, and the following
into the second class: eighth, colchicum in acute gout; ninth,
iodide of potassium in certain forms of periostitis; tenth, iron
in chlorosis and amenorrhea; eleventh, arsenic in scaly skin
diseases; twelfth, copaiba and cubebs in gonnorrhea; thirteenth,
nitro-muriatic acid in oxaluria ; fourteenth, super-tartrate of po-
tassa in Bright's disease, with diminished urine and dropsy ; fifth-
teenth, oils and fats in parasitic diseases of the skin.

" These remedies, though not so valuable, must, I think, be
admitted to be also curative in certain cases by the majority of
practitioners.

"As to blood-letting in inflammation, mercury in syphilis,
and iodine in scrofula, I consider their value, though highly
lauded by some, to be more than questionable. The fifteen
remedies named, therefore, I consider to constitute all the posi-
tive agents we possess capable of curing disease or morbid states
when they are once fairly established. Many other drugs re-

256 Calomel.

lieve symptoms — are palliative and most useful during our treat-
ment of disorders — but I repeat, as curative, I shall only be too
happy to hear of any I have omitted." (Pages 335, 336.)

The cheerless and gloomy prospect by which the wandering
Jew was surrounded when he stood on the frozen shores of
Behring Straits, was not more desolate and forbidding than the
picture of the fifteen remedies enumerated by Dr. J. Hughes
Bennett as the total result of all that has been accomplished
since the days of Hippocrates in a department of knowledge
which assumes to be called medical science.

John Stuart Mill could hardly have had this picture before
his mind's eye when he maintained, in opposition to M. Auguste
Comte, that medical science was among the highest, if not the
highest and most difficult departments of human knowledge.
Who can wonder at the popularity of homeopathists in the most
intelligent communities when such a picture is pr'esented to cul-
tivated and thinking men by a London medical savant The dis-
ciples of Hahnemann could say, we are thinking men even if our
infinitesimal doses are but an offshoot from the metaphysics of
St. Thomas Aquinas, who wrote a book to solve the problem as
to how many angels could dance on the point of a cambric needle
without jostling each other. This picture takes us back to the
Oreek empirics, who eschewed and rejected all explanations of
the action of medicines, which they called theoretical absurdi-
ties. If such is the sum total of the practical part of the physi-
cian's art, then all attempts to find out the laws of healthy life,
all attempts to find out the departure from those laws, and the
causes of them, all attempts to find out the therapeutical action of
remedies, are but so much labor thrown away; and we had just
as well follow the teachings of a Fetich or Indian doctor.

But let us consider the qualifications of Dr. J. Hughes Ben-
nett for making the report which has made so profound an im-
pression on the medical world. A man ought to know some-
thing about a thing before he can be supposed to be qualified to
make a report upon it. What did Dr. Bennett know about the
bile? He believed that bile is not formed out of effete matter.

Calomel, 257

He believed that cholesterin, one of the excrementitious prin-
ciples found in the bile, is not formed in and by the liver. He
believed that urea and other excrementitious principles found in
the urine are not formed by or in the kidneys. He believed that
the living organisms, siich as nerve, muscle, etc., not only have the
power to form and to re-form themselves, but that they also have
the power inherent in them to form or create excrementitious
proximate principles, such as cholesterin and urea; or that the
capillaries have the power to perform both of these functions.
He believed that urea and cholesterin are normal constituents of
certain organisms, as of the muscles in the one case, and of the
crystalline lenses and the nerves in the other. He believed that
all of this was accomplished under the double w^orking of con-
structive assimilation and destructive metamorphosis going on in
animal bodies at the same time. He believed that the only office
of the kidneys was to separate from the blood proximate prin-
ciples whi^h had been formed somewhere else. He believed that
the kidneys in this way removed all effete matter from the blood,
and that the only channel of exit for it was through the bladder
and urethra. He believed that the bile was not a constituent
part of the feces, and therefore that it was not an excrementitious
fluid. He believed that the liver only separated cholesterin from
the blood after it had been formed somewhere else. He believed

that the bile was reabsorbed, and therefore that it was a recre-

»

mentitious substance.

I say that he believed all this because it is so taught in the
books, and he does not intimate that he rejects their authority.
I say that believing all this, he did not know under what cir-
cumstances the bile ought to be expected to flow freely. He had
never conceived the idea that the largest quantity of bile is
formed from the food when the animal is in good health. Not
knowing this, he could not see, or did not see, how the adminis-
tration of calomel or any other drug would interfere with diges-
tion and the absorption of food, and thus prevent a free flow of
bile immediately after eating, and while digestion was going on.
h He had no conception of the fact that when the bile is not formed

17

258 Calomel.

from the food, the only other condition under which it is formed
is when the blood is charged with effete matter, and that this
effete matter must be removed from the blood by the liver as bile.

If the calomel or podophyllin was given to dogs in good
health it would make them sick, and thus interfere with the
proper digestion and absorption of food. This would prevent
the normal and regular formation of bile from the food, or viti-
ate it and alter its character. If the drugs were given to sick
dogs, they were not the medicines suited to the nature of dogs,
for they eat grass when they are sick, and select particular kinds
of grasses. So the experiment in that case would be worth
nothing. Deer eat tobacco for food, and hogs, it is said, are not
poisoned by arsenic. Experiments on the inferior animals prove
nothing as to the therapeutical effects of medicines on human
beings. Medicines, properly so called, make healthy people sick,
because they interfere with and interrupt the digestion of food
and the conversion of it into blood. They relieve ]^e sick or
are curative when they remove the impediments to healthy diges-
tion. Such certainly is the method of cure, so far as emetics and
cathartics are concerned. These medicines should only be given
to regulate and to correct the secretions and the excretions; and
to know when and how to give them is what constitutes the skill-
ful and successful physician. Such considerations do not enter
into the vocabulary of Dr. J. Hughes Bennett's art.

Not one of the fifteen medicines named by him exerts any
direct influence upon either the secretions or excretions. A man
believing as he does can not understand why calomel given in
sufficient doses promptly arrests and cures cholera infantum and
Asiatic cholera. If he were to stand by and witness such cases,
he might be compelled to admit the fact that the patients got well
after taking the medicine, but he would have no conception as to
how it was accomplished. It would be to him simply an empir-
ical fact. No report ever made out by a committee of physi-
cians could throw greater discredit upon experiments made on
the inferior animals, and by vivisections than ought this one to
do. It should convince all men, and particularly physicians,

Calomel, 259

that. experiments so made and of this class are almost always not
only valueless for good, but that they are deceptive and injurious.
The practice which is founded on this report and its concomitant
teachings has caused^ the death of tens of thousands of children,
who died from cholera infantum, and of an equal number of
adults who died of Asiatic cholera, nine tenths of which ought
to have been cured.

I am well aware of the mountain of difficulties against which
I have to struggle. I know the intense prejudice of the people
against calomel, and I know that physicians have contributed
more than any other men to this prejudice. Scientific men will
denounce me for trying to overturn their theories, and I will be
held up to the world by them as an ignoramus; and all the little
dogs will bark at my heels, and will yelp ! yelp ! " big doses of
calomel.^' All sorts of^ lying quackery will present my book to
the world as another production by what they call an allopathic
physician in defense of the administration of poisons.

As to the use of calomel at the present time by scientific
physicians, I copy from one of the most recent standard works.
Edward John Warring, M. D., F. R. S., in his work on Practical
Therapeutics, says, "Amongst the revolutions in modern medical
opinion, few, if any, are more conspicuous than that which
relates to calomel, not only as a cholagogue, which is noticed
elsewhere, but as an antiphlogistic possessed of special powers
in controlling and subduing inflammation, especially of serous
membranes. For upwards of half a century after its claims in
combination with opium were prominently set forth by Dr. Ham-
ilton of Lynn Regis, in 1783, it maintained the highest repute,
which is the more extraordinary from the circumstance that it
was employed almost indiscriminately in almost all diseases of
an inflammatory type. With the change which has come over
our views as to the nature of inflammation, mentioned in consid-
ering tartar emetic, has ensued a change in practice, and calomel
has fallen from its high estate, and there is now a danger of this
remedy, possessed beyond a doubt of powerful virtues, falling
into undeserved neglect." (Page 318.)

260 Calomel.

As to the cholagogue powers of calomel he says, " In diseases
of the liver no remedy has been employed so generally and
indiscriminately as mercury ; and up to a very recent period its
cholagogue virtues were firmly believed in by the majority of the
profession. The belief in its powers in this respect has been
upset by the experiments of Dr. Bennett and others (ante) ; and
apart from this it has been superseded in the practice of many by
podophyllin, which is thought to possess all the virtues without
the disadvantages of mercury. Under these circumstances there
is a great chance of mercury, in hepatic affections, falling, as
other medicines have done, into undeserved neglect. There are
cases, e. g. congestion of the liver, in which a full mercurial
(calomel) purgative is of undoubted utility. Under its adminis-
tration the local weight, pain, fullness, and other symptoms sub-
side simultaneously with the occurrence of copious bilious stools,
and it is impossible to disabuse the minds of those who have
repeatedly witnessed those simultaneous effects of the idea that
they bear intimate relation one to another.^'

"The most plausible, and probably the true, explanation is
that given by' Dr. Murchison (pages 126, 404) ; namely, that mer-
cury in these cases acts by irritating the upper part of the small
intestines, propelling onward the bile as fast as it is poured into
the duodenum, thus preventing its reabsorption, and that the bil-
iary accumulations thus excreted, constitute the ^ bilious stools,'
which V have generally been regarded as the result of increased
biliary secretion from the liver itself." But as Dr. Murchison
observes, "If the calomel acted by stimulating the liver to in-
creased secretion, it would be injurious in cases of hepatic con-
gestion.''

In addition to the above explanation. Dr. Murchison con-
siders that mercury may perhaps also act by stimulating the gall-
bladder and bile-ducts to contract through reflex action. By
adopting Dr. Murchison's hypothesis, it is easy to understand
how it is that jaundice sometimes yields rapidly to a calomel pur-
gation (grs. V.) followed by a saline draught, and also how it
will prove useless, and probably injurious, when the affection

Calomel, 261

is connected with obstruction by gall-stones or organic diseases
of the liver. (American edition, pages 324, 325.)

It would be too great a departure from my subject to notice
even the changes in medical opinion as to the nature of inflam-
mation, which are supposed by Dr. Warring to have contributed
in some measure to the disuse of calomel in the treatment of
inflammatory diseases; but to a simple-minded man like myself,
it seems difficult to understand how a change in the theory could
alter the facts. If calomel for half a century, given almost indis-
criminately, was found to be curative in the treatment of such
affections, I can not see how it should, be to-day less curative,
even if it was formerly given under an erroneous theory. I
deny the truth of the theory which rejects it. I have referred
to the pious Scotch doctor, who said that with a phial of calomel
and the blessing of God, he could cure all the children in the
kingdom.

Dr. Warring accepts the theory that the bile is reabsorbed,
and he is therefore bound to admit that it is a recrementitious
and not an excrementitious substance, yet he allows that it does
sometimes pass through the bowels. He also admits that in
some forms of disease the patients are benefited by the pass-
ing off of the bile. This is altogether unintelligible to me. If
the bile is a recrementitious principle, then it ought to remain in
the system, as much so as the saliva, gastric and pancreatic juices.
I did not know that the throwing away of saliva by spitting was
ever thought to benefit the health of any body. I know it makes
tobacco-chewers thin. If the theory of absorption is true, then
any thing which prevents absorption and causes the bile to pass
out of the bowels ought to be injurious, for it must disturb the
natural and healthy functions. But Dr. Warring admits that
the bile does pass off under many different conditions, and I do
not think it is too much to say that he admits that patients are
benefited thereby.

Dr. Warring seems to adopt as unquestionably true the sup-
posed demonstrations of Dr. Bennett; but he undertakes to

262 Calomel

explain the difficulty in which he finds himself by accepting a
theory of Dr. Murchison. This learned and truly distinguished
physician supposes that mercury in these cases acts by irritating
the upper part of the small intestines, propelling onward the bile
as fast as it flows into the duodenum, thus preventing its reab-
sorption. It seems to me that if this hypothesis were true, small
doses of castor oil repeatedly given would as certainly push the
bile out of the bowels without disturbing the equanimity of the
system by the irritation of the duodenum. But Dr. Murchison
himself seems not to have been satisfied with this first explana-
tion of the action of mercury or calomel, for he gives us another.
He supposes the mercury may, perhaps, also act by stimulating
the gall-bladder and bile-ducts to contract through reflex action.

For a long time, when a physician was unable to explain some
difficulty in a case, he concealed his ignorance by saying that the
thing was caused or produced through sympathy.

To-day the same ignorance is covered up by the words, reflex
action. It is used continually by men who assume to be scien-
tific, who could not, if their life depended upon it, tell what they
meant by it.

Notwithstanding the high authority of Dr. Murchison's name,
the explanation here given is an absurdity. If calomel excites
or stimulates the liver to secrete and to pour out bile, as I know
it does, why suppose that the therapeutic effect is the result of
reflex instead of direct action?

But Dr. Murchison also supposes that if calomel acted by
stimulating the liver to increased secretion, it would be injurious
in cases of hepatic congestion.

Whenever the liver itself is diseased, calomel, if given at all,
must be given very cautiously. In those forms of disease in
which calomel acts most beneficially and curatr\^ely, as in cholera
infantum, Asiatic cholera, and miasmatic fevers, and many forms
of inflammation, the liver is itself not diseased; but is only func-
tionally at fault in the secreting and pouring out of bile.

We give calomel in all such cases to stimulate the liver to
increased work, and we continue to give it until the difficulty is

Calomel, 263

removed. But, if bile is a recrementitious principle, if the
physiological function of it is that it should be reabsorbed; if
it is not formed from effete matter, then calomel should never
be given under any circumstances. Not only so; if I am en-
tirely wrong, then an emetic should never be given except to
throw off undigested food from the stomach to relieve a colic ;
and cathartics should never be given except to remove accumu-
lated feces from the bowels. I repeat, if I am wrong, and the
scientific medical world in opposition to me is correct, then, with
the two exceptions which I have named, the homeopathists are
right, because the infinitesimal doses which they give do not dis-
turb the equanimity of the system.

Dr. Warring admits "that cathartics are used to excite in-
creased biliary secretions, and to stimulate the action of the
absorbents in all parts of the body. To promote the discharge
of other secretions; thus, the previous use of purgatives often
apparently promotes the action of diuretics." He says, "Most
cathartics operate on a particular part of the intestinal canal;
thus calomel, jalap, and colchicum stimulate the duodenum, and
promote the discliarge of bile."

Dr. Warring says, "Purging, observes Sir T. Watson, is an
expedient which, in cases of violent imflammation or high gen-
eral fever, should scarcely ever be omitted. To keep the bowels
what is called open, forms indeed a part of the antiphlogistic
regimen; but in acute inflammatory diseases, active purging is
of very great service." (Pages 660, 661.)

It is difficult to understand the last' quotation, when we know
that Dr. Warring accepts the experiments of Dr. Bennett as
conclusive; and also that he accepts the theory of the absorp-
tion of the bile. But yet he and many other distinguished med-
ical writers who agree with him, speak of the bile passing from
the bowels in different diseases, and admit that the patients are
benefited thereby.

Now I think that no physician can dispute that if calomel
does not excite the liver to action no other medicine does. The
medical gentlemen to whom I refer adopt a theory that the kid-

264 Calomel

«
neys remove the effete matter from the blood. I say that, if

they are correct, cathartics should never be given; and this
applies particularly to calomel, which sometimes produces inju-
rious effects. It is because cathartics, especially calomel, stimu-
late the liver 'to the increased secretion and pouring out of bile;
it is because this bile is formed out of effete matter ; it is because
the removal of effete matter from the blood, by the liver, les-
sens the congestion of the abdominal viscera; it is because the
capillary blood-vessels (the real absorbents) are then enabled to
take up more rapidly effete matter, as it is separated from the
living organism by destructive metamorphosis. I say that it is
because of all this that the many afflictions humanity is heir to
(and particularly those referred to by Dr. T. Watson), which are
benefited by cathartics, are relieved and cured.

Dr. Warring says that '^the previous use of purgatives often
apparently promotes the action of diuretics." This is not only
80, but it often happens that a free discharge of bile, following a
dose of calomel, enables the kidneys to secrete urine plentifully
from the blood without the administration of any remedy be-
longing to the class of diuretics. Now this is altogether unin-
telligible, according to the theory that the kidneys remove effete
matter from the blood; but it is as plain as a nose on a man's
face, according to the theory of Dr. Cooke and according to my
theory inclusive.

The renal veins, which empty into the vena cava, have no
valves, and when there is congestion in the veins of the abdom-
inal viscera, this congestion extends through the renal veins into
the kidneys.

The congestion of the abdominal viscera, for the most part, is
a coexisting condition when destructive metamorphosis is going
on, and when a large amount of effete matter passes into the
venous circulation. The removal of this effete matter by the
liver relieves the common congestion of the venous cavity, and
the particular congestion of the renal veins. The kidneys being
thus relieved, re-commence their healthy action in a vigorous
manner. But if they alone remove effete matter from the body,

Calomel. 265

then if a man, in every form of disease in which there is con-
gestion of the abdominal viscera, should urinate by the gallon,
it would not relieve the congestion. This is another proof of the
absurdity of the belief or theory that the kidneys remove the
effete matter. We know, where the congestion spoken of exists,
that the kidneys secrete urine very sparingly.

To this the disease called diabetes is the only exception. I
believe that all regular physicians admit that congestions of the
brain and apoplectic seizures are most certainly relieved by
cathartics; and I do not doubt that many of them will acknowl-
edge that this relief is the speediest and most apparent when
bile is copiously discharged with the stools.

Now I assert that calomel is the most effectual and certain
remedy in the affections of the brain referred to.

If the reader will refer again to the extracts from Dr. Cooke,
he will see that congestion of the brain can not exist without coex-
isting congestion of the vena cava and of the abdominal veins,
(I am not now referring to arterial hyperemia of the brain.)

Calomel in these cases causes the liver to separate the effete
matter from the blood. By this not only is the congestion of the
brain in particular removed, but also the general congestion,
and every organ in the body is enabled to perform its functions
more healthfully.

In the spring of 1861 I wrote an article on the facts, pub-
lished in the newspapers, as to the cause or causes of the death
of Count Cavour, and sent it to Eev. W. W. Hall, M.D., for
publication in his Hall's Journal of Health.

It was supposed that Count Cavour died from congestion of
the brain. I thought it more than probable that the immediate
cause of his death was imprudent if not excessive blood-letting.
In that paper I discussed the question of congestion of the brain,
and also when and why a man should be bled. In the latter I
agreed with Marshall Hall. Kev. W. W. Hall, M.D., selected
from my article such parts as he liked, and published them as
his own, without so much as intimating that he ever heard of
such a man as myself.

266 Calomel

Afterward, when I complained of this treatment, he said that
he did not publish communications in his journal, but only what
he himself wrote. But it seemed that his mind was not easy
about the matter, so he published the next year a short extract
from my article which he had before omitted, in which I said
that in a case such as I supposed Count Cavour's to be, I would
have given sixty grains of calomel. He was willing to publish
my name in connection with this avowal.

Well, I am ready to stand by that to-day. I am satisfied that
I and the school to which I belong not only know when to give
calomel, not only know for what reason we do give it, but also
know how much to give.

I am perfectly satisfied that the reason why physicians gen-
erally entertain so many erroneous opinions as to the therapeutic
virtues of calomel, is because they give it in quantities too small
to make any appreciable impression on the liver; and because
they do not know that small doses of calomel excite too much
the mucous membrane of the stomach and bowels, while scruple
and dram doses not only quiet the bowels but also allay the irri-
tability of the whole system.

I may give a few cases which have come under my own
observation, but, as I am not writing for fame, but with the
hope that I may prevent the untimely death of thousands, I
refer again to Dr. Cross.

In the Western and Southern Medical Recorder, for 1842,
in an article, Notes on the Sedative Action of Calomel, he says,
" We have for more than twelve years practiced upon the princi-
ple that the effects of a large dose of calomel are different from
those that result from a small one. By a large dose we mean
twenty, and by a small one five, grains.

" Although we urge no right to the original suggestion here
alluded to, as we frequently meet with practitioners who are
ignorant of the fact, or unwilling to acknowledge its impor-
tance, we shall not be trespassing upon the indulgence of our
readers by pressing its claims with such facts as we have ob-
served, and such arguments as may occur to us.

Calomel. 267

" We rarely ever use calomel as a purgative. It is slow and
uncertain in its action, and therefore much more inefficient than
many other articles to be found in the class of cathartics. When
the secretions of the chylopoetic organs are deranged we always
give it for their rectification, either alone or with some purga-
tive, for the purpose of increasing its activity. With disorders
of the organs referred to, there is commonly associated an irrita-
ble condition of the alimentary tubes, and when this is the case,
we have uniformly found that a scruple or half a dram of calo-
mel is much more effectual in moderating inordinate activity of
the intestinal tube — in arresting the copious serous secretions of
the bowels, almost always present under such circumstances, and
in provoking the liver to action, which is generally at fault —
than any smaller quantity."

Twenty grains will commonly bring down two or three con-
sistent and bilious evacuations, while five or ten will usually
increase the peristaltic atjtion of the bowels, and will cause the
evacuations, by irritating the stomach and bowels, and thus aug-
menting the serous and mucous secretions, to be frequent, liquid,
and exhausting. It is in cases of irritable bowels, in which
frequent watery stools are passed, that calomel, either alone or
in combination, is always given, and it is therefore of the
utmost importance to know what quantity is calculated to do
the most good. On this point my mind has long been made
up,, and I am satisfied that my success in treating intestinal com-
plaints has been mainly owing to the fact that I have kept con-
stantly in view the marked difference in the effects that result
from large and small doses of calomel. Indeed, so thoroughly
am I convinced that the efficacy of this mineral mainly depends
on this circumstance, that I am not surprised at the very con-
tradictory effects it has produced in the hands of those who rely
upon five- or ten-grain doses. That they should have little con-
fidence in it, is not wonderful, for they give it, m we believe, in

quantities that are calculated to do more harm than good

Nor does the mode of the action of the calomel, which we
desire to illustrate, rest upon our authority. If has been re-

268 Calomel

peatedly observed and verified in actual practice by those who
have enjoyed the most favorable opportunities for arriving at
truthful results.

Mr. Abernethy, who practiced many years in India, says,
"Small doses of calomel, from two, three, four, etc. grains, will
purge and keep up a considerable degree of irritation in the
stomach and bowels, when twenty grains will not, but on the
contrary will allay the irritation of both."

On the same subject Dr. Johnson says, " I shall prove in the
course of this essay, what, indeed, is well known to many of our
brother ofi&cers who served in India, that twenty grains of calo-
mel will act as a sedative, and so far from griping and producing
hypercatharsis, it will soothe uneasiness, and rather constipate
than purge." Again he says, "1 have myself taken calomel in
twenty-grain doses three times a day, without experiencing the
slightest inconvenience from the quantity; nay, I often found
large doses set easier on the stomach and occasion less irritation
in the bowels than small ones."

By Dr. Merrill, of Natchez, Mississippi, it is said, " Calomel,
when given alone, I have always found to produce the best effects
when given in scruple doses. A smaller quantity than this oper-
ates more frequently, producing more irritation of the stomach
and bowels, and causing frequent watery dejections, which rap-
idly debilitate the patient."

Dr. Cartwright, of Natchez, and afterward of New Orleans,
remarks that "Those who have not used calomel extensively
would be apt to suppose a priori that large doses would produce
hypercatharsis and debilitate the patient; but experience can
best refute such suppositions, for it shows us that large doses
of calomel operate much more mildly than smaller ones."

The late Dr. Armstrong says, " Small doses of calomel, from
two to five and six grains, will purge and keep up a considerable
degree of irritation in the stomach and bowels, when twenty
grains will not; but on the contrary, will allay the irritation of
both when it results from inflammation of their mucous surfaces.

Dr. Thomson, in his work on Materia Medica and Therapeu-

Calomel. 269

•

tics, informs us that "it often happens that small doses of cal-
omel can not be retained in the stomach when this viscus is in
an irritable state, although it retains large doses which act as a
sedative." My own experience has afforded me numerous illus-
trations of this remark.

Dr. Lewis, in a very recent article on Tropical Dysentery,
speaks in terms of great praise of the treatment followed by Dr.
Heyn at Java in that disease, which consisted in administering
at the very outset of it a scruple of the chloride of mercury.
According to his experience, this powerful pharmaceutical agent,
when employed in small doses, acts as an irritant, but when given
in large quantities, has so decided and immediate effect as to
merit the name of a direct sedative.

The concurrent testimony of so many respectable physicians,
who have deduced their opinions from actual observation, can
not fail to satisfy all that the effects of a large dose of calomel
are very different from those of a small one, and that while the
former allays the irritability of the bowels, the latter rather aug-
ments it than otherwise.

Dr. Cross gives a number of cases which came under his own
observation confirmatory of what is written above. I have only
space to give one of them :

*^ In 1829 a lady in the first months of pregnancy was afilicted
with excessive vomiting, so much so indeed that her friends and
physician became apprehensive that she could not live. After
other expedients had been used, small doses of calomel among
the rest, she took a dram of calomel at a single dose, and the
irritability of the stomach was at once calmed, and it did not
return again to such an extent as to cause uneasiness."

There are hundreds of physicians now practicing in the Mis-
sissippi Valley who would confirm the truthfulness of the posi-
tions taken by Dr. Cross; but the number of them is growing
smaller every year. The younger physicians can but receive
as the highest scientific truth what is taught in the first medical
schools in this country and in Europe. Being taught that the
kidneys remove the effete matter from the blood ; that the bile is

270 Calomel,

m

a recrementitious principle; and that its healthy physiological
function is to be reabsorbed ; and receiving as the Q. E. D. of
geometry the demonstrations of Dr. J. Hughes Bennett, it is not
singular that they can not understand why calomel should ever
be given; and when they do prescribe it, as directed in the
books, they give it in very small doses often repeated; finding
that their patients are frequently salivated, it is not strange that
they should prefer podophyllin or any thing else in preference to
mercury.

And here I would remark, in passing, that no physician
knows any thing about the therapeutical or curative effects of
calomel who ever intentionally salivated a patient, except, per-
haps, in the treatment of iritis.

As to the particular action of calomel. Dr. Cross says, " It is
said that mercury brings down, habitually, morbid stools. This
is true in a particular sense only. If we are to understand by
it that the alvine evacuations never assume a healthy appearance
so long as the preparations of mercury are continued, the charge '
is wholly unfounded."

Mercury is the great rectifier of biliary derangement; it is
known to possess more power in exciting and increasing the
secretion of bile than any other article, and consequently when
it is given it is natural to expect a greatly increased afflux of that
fluid into the bowels. Now if the color of the stools be owing,
as all must admit they are, to the presence of bile, it is very cer-
tain that when it is secreted in a larger quantity, or in a more
concentrated state than usual, the dejections must be made darker
than common, and this is often so remarkably the case that it
renders them as black as those that are colored by sulphur or any
of the preparations of steel.

Nor is it necessary for the chylopoetic organs to be in a mor-
bid state for mercury to produce this effect. From the bowels
of an individual in perfect health a scruple of calomel will cause
to pass one or two stools of a much darker complexion than that
which is natural to them, while a second dose will have no effect,
but will bring down the contents of the bowels of a natural

Calomel, 271

color; and if the mineral should be persevered in, under such
circumstances, they are apt to assume a preternaturally light
hue, which sometimes goes on progressively increasing until they
ultimately become nearly white. Now how are these various
dejections under the use of calomel to be explained?

If the physiology of the liver, which we have endeavored to
illustrate and explain, be admitted as correct, we shall encounter
no serious difficulty in giving to this question a satisfactory
response.

It must be recollected that we have endeavored to prove that
the materials of the biliary secretions consist of the effete or
refuse matter of the fluids and solids of the body. Assuming
this as conceded, all will agree that when the liver is in the
active discharge of its duty, the quantity of bile found in that
organ and poured into the bowels must be very much in pro-
portion to the amount of the elements of bile found floating in
the abdominal venous circulation, and that in a state of perfect
health they are not more abundant than is compatible with the
complete integrity of the functions of the economy.

Several medicinal articles are believed to possess the power of
increasing the biliary secretion, and of these calomel is admitted
to be the most certain and effectual. When, therefore, calomel
or any other preparation of mercury is given to an individ-
ual in good health, the activity of the hepatic function is in-
creased, and the elements of bile are separated, in a given time,
in greater quantity than when the liver is under no such influ-
ence. This causes an augmented afflux of bile into the bowels,
which gives rise to the dark hue which the alvine evacuations
present after a first dose of calomel has been taken. The activity
imparted to the liver by the first dose causes a rapid elimination
of bile, and a consequent diminution of the quantity of effete
matter in the venous circulation of the abdomen, and when a
second is given on account of the deficiency of its elements, the
amount of bile formed is much reduced, and the dejections
assume a natural complexion.

Let the mineral, however, be persevered in; the liver thus

272 Calomel

goaded will separate the elements of bile from the portal blood
more rapidly than they will be thrown into the abdominal capil-
lary veins by the intestinal absorbents, the consequence of which
will be a gradual diminution of the quantity of bile formed, and
a corresponding diminution of the rhubarb color of the stools,
until at last they will become white.

The production of white stools has been mentioned as one of
the effects of mercury, and they have been urged as an argument
against the alleged peculiar efficacy of mercury to activate the
biliary secretions. When they occur after the use of mercury
and are disconnected with the jaundice, they should be regarded
as resulting from an injudicious perseverance in a powerful med-
icine, which has caused a deficiency of the biliary principles.

This explanation of white stools is given by Dr. Thomson in
his recent work on the Diseases of the Liver and Biliary Pas-
sages, though he undertakes not to explain how the deficiency of
the biliary principles is produced.

By the author to whom reference has just been made it is
asked, "May white stools occur in cases in which there is no
jaundice, and if so, how can this phenomenon be accounted for?
The only explanation which it seems possible to give of the oc-
currence is, that the blood is deficient in appropriate elements of
the biliary principles, and that any fluid which the liver secretes
is consequently deficient in these principles, for if the want of
the due constitution of the bile depended, not on deficiency of
proper materials in the blood, but simply on the liver being
capable of separating them from that fluid, jaundice must arise
from their retention as in the class of cases already referred to."

If there is any plausibility in the explanation above given, it
is altogether probable that the varied appearances exhibited by
the alvine dejections, and which have given rise to the assertion
that mercury " habitually brings down morbid stools," results not
necessarily from any morbid modification in the biliary secretion,
but from the quantity of that fluid poured into the bowels; that
although appearances seem to justify the allegation, there is evi-
dently a period, during the administration of mercury, when the

Calomel 273

amount of bile discharged into the bowels is neither excessive
nor defective, and when, as .a natural consequence, the fecal con-
tents of the bowels present their natural character. This is, as
we shall hereafter endeavor to show, the circumstance which in-
dicates that mercury has been pushed far enough, and that to
persevere in it longer is to run the risk of converting its sani-
tive into its morbific action. When, therefore, it is said that
mercury brings down morbid stools, we are to understand that
it causes the flow of an abundant and concentracted bile into the
bowels, or that, from misapprehending its mode of action or the
object to be attained by its administration, it has been enforced
longer than is necessary or proper."

Two things must be observed in the above extract; the first
is, that Dr. Cross has no knowledge of the physiological law,
that in a state of perfect health the bile is formed from the
food. Now my doctrine is, that in perfect health, when destruc-
tive metamorphosis is not at work, the food and efiete blood are
the only materials from which the liver separates and forms
bile ; and also that the large quantity of bile daily poured out
into the duodenum in perfect health can only be accounted for
in that way. This qualification has before been explained.

Second. Dr. Cross does not notice here, nor in any of his
essays on the Function of the Liver or Intestinal Absorption,
the source from which the urine is derived.

If, as he teaches, and as I believe, the bile is formed from
effete matter, then we must account for the solid constituents
found in the urine in some other way. I say they are formed
from the food which is carried along in the current of arterial
blood to the kidneys, just as the first bile is formed from the
food brought to the liver through the portal veins.

Both of my assertions demand the most deliberate considera-
tion of physiologists before they reject them.

I know nothing personally of the white or light-colored al-
vine discharges following the administration of calomel, spoken
of by Dr. Thomson and Dr. Cross. I have no confidence in the
supposed therapeutical discoveries for the relief of human mal-

18

274 Calomel.

adies arrived at by experiments on the lower animals ; nor have
I much more confidence in conclusions drawn from experiments
made by giving medicine to persons in good health. The in-
stances referred to by Dr. Thomson were those in which the
individuals were sick, and in whom destructive metamorphosis
was at work. In these cases, I think. Dr. Cross's explanation is
probably correct. But in the cases to which calomel was given,
when^ the individuals were in perfect health, I suppose that the
calomel given in repeated doses, so far interrupted the healthy
functions of digestion as to prevent the liver from separating
the usual quantity of bile from the food, without interrupting
the general health so far as to set at work the process of destruc-
tive metamorphosis, by which effete matter would be thrown
into the venous circulation. Besides, the individuals in perfect
health selected for the experiments, were not, perhaps, after all,
entirely so. Destructive metamorphosis may have been at work
a short time before the experiments were made, and a smaller or
larger quantity of effete matter would be in the venous circula-
tion. The first dose of calomel stimulated the liver to remove
this from the blood. The repeated doses only interrupted the
functions of the liver in the secretion of bile. This is probably
the correct explanation.

In another place Dr. Cross says, " We suppose that there is
always a portion of refuse matter in the portal circulation that
is compatible with health; that in certain diseases it is accumu-
lated in undue quantity; and that when the alvine dejections,
under the use of mercury, resume a natural character, all the
refuse matter incompatible with health has been removed."

Dr. Cross again says, " More than once have we already al-
luded to the close connection that subsists between the liver and
the skin, which by Dr. Johnson is denominated cutaneo-hepatic
sympathy; and by which is understood a mutual dependence of
function between these organs, which causes the particular state
of one of them to produce a similar state of the other; that
when there is an open state of the skin, there is at the same
time an unobstructed state of the liver; that when the former

Calomel. 276

pours out perspiration freely, the latter discharges bile into the
bowels abundantly, and vice versaJ^

Now to whatever principal recourse he had to explain this
correspondence of action, no doubt can be felt by any physician
who has practiced in warm latitudes, as to its actual existence.
External heat is one of the principal causes of undue or excess-'
ive excitement of the skin, and it must therefore give rise to a
copious afflux of bile. The quantity of bile mixed with the
alvine dejections, being thus increased, a darker color than nat-
ural will be imparted to them, and they frequently become more
acid than usual, causing more or less heat and sometimes pain
during their dejection.

In accordance with a principle of easy and familiar applica-
tion, which is that organs which have been exerted for a length
of time become fatigued, perform their functions languidly and
feebly, and are apt ultimately to fall into a state of torpor. In
hot climates the skin is peculiarly exposed to this accident, and
when it happens, the biliary overflux which accompanied free
diaphoresis not only ceases, but the action of the liver is com-
pletely suspended, and then acute chylopoetic disease immedi-
ately ensues. This result is of much more frequent occurrence
in southern latitudes than it otherwise would be.

Were it not that the influence of external heat is too com-
monly associated with the abundant use of distilled and fermented
liquors, which greatly increase the eifects of a high temperature,
and consequently the function of the skin, already enfeebled by
overexertion, is more easily checked by a more humid atmos-
phere, to which the inhabitants imprudently and without reflec-
tion expose themselves.

Now wherever there occurs, in those regions in which acute
abdominal diseases prevail to much extent, a biliary overflux, as
indicated by the alvine evacuations, the danger to be appre-
hended is of an entirely opposite state of the biliary organ — a
torpid condition of the liver; and this very common result it
should be the aim of the physician to prevent.

This is undoubtedly the indication which is to be fulfilled.

276 Calomel

How is it to be accomplished? Evidently by such means as will
achieve the twofold end in sustaining the liver in the perform-
ance of excessive duty, and of restoring the biliary secernents to
their natural action. If mercury will increase the biliary secre-
tion, it will of course sustain the action of the liver, and if the
dejections become healthy in appearance under its use, it is of
course by restoring the biliary secernents to their natural action.

That it excites the liver, is admitted by all, and that the
stools assume a natural appearance under its use, we have
already proved; therefore mercury is the article on which we
should rely to diminish an overfiux of bile.

The judicious and timely interposition of an occasional dose
of calomel or pillulse hydrarg. will soon bring the stools to a
natural color, and then all solicitude on the subject will cease to
be experienced.

Quietude, confinement within doors, and some gentle tonic,
such as decoction of columbo, will restore the previously over-
excited organs to a normal condition. In addition to the above
and in agreement with it, I know that the excessive drinking of
alcoholic or malt liquors often stimulates the liver to an increased
secretion and pouring out of bile, so that there is a sort of bil-
ious diarrhea, which is sometimes followed by torpidity of the
liver and costiveness. There are no more certain and effectual
remedies for this last condition than a thorough emesis and a
scruple dose of calomel. Sometimes the emetic itself will be
sufficient. It arouses both the liver and skin to healthy action.

Some very distinguished physicians have attributed green
stools to the action of calomel. Upon this subject Dr. Cross
remarks: "During infancy it is not uncommon for green stools
to pass from the bowels that are copious, thin, mixed sometimes
with mucous flocculi that resemble closely - cropped grass or
spinach. Alvine dejections, more or less green in appearance, are
sometimes passed by adults, but they are not so liquid as those
which come from children. In regard to the source of such de-
jections much discrepancy of opinion exists among physiologists.
That this should not happen must be a matter of surprise to

Calomel. 277

every thinking mind capable of taking a comprehensive view of
the subject. Cystic bile is green or black, and therefore green
stools should be ascribed to the liver, unless the most positive
proof can be adduced that they come from some other source."

Cystic bile, as we have said, is of various shades of green or
black, the color of it depending upon the length of time it has
been retained in the gall-bladder, and when black, if diluted
with water it becomes green.

It must be recollected that bile is not green when it is secreted,
but assumes that color during its transit to and retention in the
gall-bladder, and it is therefore an acquired property, which
results from changes which are produced in it after its exclusion
from the sphere of vitality.

Green stools, consequently, coming, as they do, and as we shall
presently prove, from the liver, can not be looked upon as even
morbid in any other light than as being formed of materials
more disposed than in health to run into those changes upon
which the sensible properties of cystic bile depend. This, we
say, because either from the influence of disease or from the
action of medicines, as is proved by the copiousness and fre-
quency of green stools, the biliary secretian remains but a short
time in, if indeed it is permitted in all cases to pass at all into,
the gall-bladder.

But let us examine the explanations that have been given of
stools under consideration. As we have said, they have been
ascribed to the acidity of the contents of the prima vise. This
supposition is rendered wholly incredible by the fact to which
Abernethy and Ayre testify ; and which is, that in those cases
that proved fatal during the passage of green stools, precisely the
same fluid was found in the bile-ducts and gall-bladder. In sev-
eral fatal instances of hydrocephalus this observation we have
been able to verify

In a natural state the mucous membrane of the bowels forms
no such product from the blood, and when irritated we have no
proof that its secretion is capable of undergoing any such change.
Did Professor Graves or any other pathologist ever find the con-

278 Calomel.

tents of the bowels green without finding a similar color charac-
terizing the contents of the gall-ducts and gall-bladder? No,
we are sure he never did.

Ammonia, soda, potassa, magnesia, and creta preparata have
often been given to children with green stools, and we have never
seen such articles produce any beneficial change in them, while a
few doses of calomel and prepared chalk have achieved in that
respect all that we desired.

I could verify the correctness of this last statement by a re-
port of many cases of infants and young children, where these
green stools appeared, which were promptly and decidedly re-
lieved by the administration of calomel in sufficiently large doses.
In the summer complaints of children and of cholera infantum,
these green stools are among the most unfavorable symptoms,
and they are often accompained by irritability of the stomach
with frequent vomiting. In such cases it will often be found
necessary to give scruple doses of calomel. The reader need not
be alarmed, for there is no remedy which produces quietude and
an entire subsidence of both vomiting and purging so promptly.
I will refer to the use of calomel in these complaints again.

Dr. Cross says, "Dr. Mills, in his work on Disorders of the
Brain, records a fatal case of diseased brain in the treatment of
which not a grain of calomel had been employed, yet throughout
its whole course green stools were passed by the bowels. He
says, during the illness the feces were greenish, an appearance
commonly imputed to the use of calomel, but which is more
properly referable to the condition of the bile ; green bile was
poured in the gall-bladder and ducts, whence it was traced to
the small and large intestines every where tinging their contents
with a green of a deeper or lighter shade, according to the
quantity and nature of the matter with which it was mixed.

" In two cases of hydrocephalus which proved fatal, while
green stools were being voided the secretions found in the gall-
bladder and ducts were very similar to, if not identical with, that
which was found in the intestines and which had passed from
them several days before death. ^

Calomel. 279

"So entirely exempt is calomel, according to our observation,
from having any tendency to produce the variety of stools under
consideration, that we have for many years regarded it as the
safest and most certain remedy that can be given for their
correction.

"Confiding in the truth of the practical views we have an-
nounced on the subject, we would, in addition, venture to ad-
monish the reader that when, under the use of calomel, green or
spinach-colored dejections change their character for the better,
he should not expect them to resume at gnce the bright yellow
complexion characteristic of healthy stools, for they will become
of a much darker green and sometimes they will be observed to
be nearly black, after which, if the mineral is properly perse-
vered in, they will become of a less and less dark color, and in a
few days they will ultimately exhibit their proper hue."

When there is decided hepatic derangement, it is useless to
expect its perfect rectification from one, two, or three doses of
calomel. It is often very slow to take hold of that organ, and we
frequently find it necessary to continue it for days in succession,
before such an impression can be made on it as is desirable."

" The dark or black evacuations, which calomel rarely fails to
bring down, have been, like those that are green, ascribed to the
chemical action of the liver upon the intestinal contents. This
opinion is daily rebuked by observation and experience. If
true, they would become darker and darker under its use, while
we know they present, in succession, various shades of color and
ultimately resume the natural complexion.

" In disease the alvine evacuations often cause a hot or smart-
ing sensation during their passage per anum. This sensation is
sometimes so intense as to be very painful, and the contents of
the bowels are often so acrid as to produce excoriation. This
acridness has been ascribed to the medicines that are employed.
This is true, but not in the way it is commonly explained. It is
supposed that the acrid and drastric qualities of certain medi-
cines give rise to the pain and excoriation just spoken of. Our
observation lends no support to this opinion. Unless the lower

280 Calomel

part of the intestinal tube is irritated or inflamed, as in dysen-
tery, we know of no medicine that renders the contents of the
bowels acrid, except those that are known to possess the power
of invigorating the action of the liver; nor do we ever find the
stools acrid, except when there is unequivocal proof of abundant
biliary secretion. Then they produce heat, smarting, and some-
times excoriation. Such sensations are never experienced in those
states of the diseased system which are distinguished by the une-
quivocal evidences of an inert liver; and therefore they may be
fairly attributed to an unobstructed condition of that organ."

I have repeatedly taken calomel in scruple doses; I have
taken cathartic pills composed of calomel, socotrin, aloes, and
ipecacuanha, and pills composed of the same medicines and rhu-
barb; I have taken pills composed of calomel and the compound
extract of colocynth ; I have noticed the stools, and sometimes
found them muddy, sometimes yellowish, sometimes green or
greenish, and sometimes very dark or nearly black. I have also
felt the burning sensations spoken of by Dr. Cross in the extract
just quoted. I have always felt relief from such discharges;
and I have also noticed that as convalescence advanced the
alvine discharges assumed more and more a rhubarb color,
with the odor and consistence peculiar to health.

The physician who would use calomel understandingly must
first acquaint himself with what constitutes healthy stools — as
to their color, consistence, and odor. I have verified these
observations through many years* practice. I am satisfied that
physicians and medical writers who object so much to the use of
calomel have never tried it sufficiently to know any thing about
its medical virtues. No modern work on the practice of medicine
or on therapeutics gives such instructions to the young physician
as would enable him to know when and how to use it. The com-
mon error is to give it in too small quantities.

The source of another error is that the books do not teach
what sort of stools calomel ought to bring down. In all forms
of disease in which there is loss of weight, destructive metamor-
phosis is at work, and a smaller or larger quantity of effete matter,

Calomel, 281

proportionate to the loss of weight, is thrown off. This effete
matter^ passes first into the venous circulation, and has to pass
through the liver or lungs, or through both, before it enters the
arterial circulation. Independent of the remote cause of the
particular affection, this effete matter is itself a disturbing cause,
involving an interruption of the healthy process of digestion,
thus preventing the proper conversion of food into blood. This
disturbs the healthy functions of every organ in the body.

It is the peculiar function of the liver to remove this effete
matter and not only to convert it into bile, but also to pour out
this bile into the duodenum. In some forms of disease, as the
exanthemata, the liver generally performs the office just referred
to sufficiently well; and there is no necessity for giving any med-
icine to excite it to increased action. The only exception to this
is when the exanthemata are of the congestive form, which is the
most fatal form. In this case it may be necessary to give cal-
omel. Ordinarily I do not give it or any other cathartic in such
affections.

I have before said that except in the forming stage of typhoid
fever I do not give calomel. I consider it to be a very doubtful
remedy in cases of dysentery, unless there be very evident signs
of congestion of the liver. But in miasmatic fevers, in cholera
infantum, and in Asiatic cholera, I believe it to be by far the
most reliable remedy. It is also a remedy of incalculable value
in many forms of chronic disease — in all those where there is
evidently congestion of the venous cavities.

In those chronic affections in which these congestions exist I
have found calomel combined with ipecacuanha, aloes, rhubarb,
and a compound extract of colocynth, or with one or two of them,
to be preferable to calomel alone, though sometimes a scruple
dose of the latter will be necessary. I believe calomel to be one
of the most reliable remedies in pneumonia. A large amount of
effete matter is often thrown into the venous circulation in that
complaint. The lungs are unable to purify the blood, as in health,
and the whold of that task devolves upon the liver. That organ
must be roused to complete action ; and sometimes the relief will

282 Calomel

be manifest before the bile passes off in the alvine discharges.
I could cite many remarkable cures of patients who have been
given up to die before I was called to see them.

I will only give one. It was the case of my fifth son. He
was four months old when he had a terribly severe attack of
pneumonia. One of our best physicians was attending the child
with me. After he had been ill three or four days and was grow-
ing worse all the time, this physician called in the evening and
said he was dying. A few minutes after he left my house a
neighbor asked him how the baby was. He replied that he sup-
posed he was dead, as he was breathing his last when he left the
house. Knowing that calomel exhilarated me like champagne
wine, I determined to try it on my child, as I did not agree with
the doctor that he was dying, and knew that he could still swal-
low. I gave him twenty grains of calomel. It aroused him in
less than an hour. This was about 7 o'clock P. M. About day-
break next morning finding that the reaction was subsiding, I
gave him twenty grains more, although the other had not oper-
ated. In the course of the forenoon black bile flowed freely
from his bowels. After this the bilious discharges were less dark,
and they soon became of a rhubarb-yellow. He took little or
no medicine after this, and convalesced rapidly. He is now one
of the stoutest young men in Colorado, being in the twenty-
second year of his age.

Calomel given in scruple or large doses operates very slowly;
and it is frequently necessary to give some other cathartic to
work it off. Given in these doses it does not prostrate, as it
sometimes does when given in small doses frequently repeated.

Many physicians who give calomel in small doses often re-
peated, give more to a patient within a given time than I do. It
is a very great mistake to suppose that calomel given in scruple
doses, even to infants, will salivate. In over forty-three years'
practice I do not think I have salivated over a dozen or at most
twenty patients, and not one of them was an infant or a young
child ; and in not a single instance have ever had cause to regret
giving calomel in these large doses.

Calomel. 283

In cholera infantum, where the bowels are continually run-
ning off, and where there is so much irritability of the stomach
that every thing swallowed is immediately vomited up, a scruple
dose of calomel will act like a charm, quieting immediately both
stomach and bowels, and producing refreshing sleep. When the
child wakes he will have a healthy appetite, and the food given
him, or his mother's milk, will be digested without interruption.
The dose of calomel, both among the young and the old, must
be determined by the physician to suit each case.

I have spoken of large doses, not only to show that they may
be given, but that it is often necessary to give them. To infants
and young children I often give calomel in half-grain and grain
doses; and to adults I sometimes give it in from five- to ten-grain
doses; but when I give calomel to adults, in small quantities, I
prefer uniting it with ipecac and some other cathartic.

But lest it may be supposed that I give nothing but calomel
or some other form of cathartic medicine with emetics, I must
here say that the practical part of this book is to explain the
uses of those particular medicines. In some forms of disease I
never think of giving a cathartic. I will refer to one of them,
a very severe malady and one which is too often fatal. I allude
to diphtheria.

Nineteen years ago, before I lost my eyesight, I treated
twenty-six cases of diphtheria at the St. Catherine's Academy in
this city. Three of the cases were very serious ones, the others
were milder. The severe cases were the first attacked, and I did
not see them until the disease had made some advance. The
other cases I saw when the first indisposition manifested itself.

I had studied the disease as reported in the medical journals
for some twenty years, and saw no good reason for giving any
internal medicine. I directed the sisters to require the girls and
young ladies to drink freely of catawba wine or good whisky
toddy, whichever they preferred. I also directed that each pa-
tient should have a plate of lumps of ice by her and that she
should keep a lump of it almost continually in the mouth. If
this was not sufficient to control the diphtheritic affections of

284 Calomel.

the throat, I had a small towel, wrung out of ice- water and
folded up, applied to the throat from ear to ear. This was cov-
ered by a piece of dry flannel. The towel was frequently re wet
in ice-water. They all had nutritious food as they wanted it.
They all used a gargle of chloronated soda one ounce, tincture
of myrrh one ounce, water six ounces. To one of the girls I
gave a dose of castor oil ; to another I gave a dose of castor oil
and some sweet spirits of niter to excite the kidneys to action.
I will describe this case more particularly. She was a young
lady in her fifteenth year, but remarkably large for her age.
The tonsils and soft palate were very much swollen. The diph-
theritic exudations were extensive. The glands about her neck
externally were very much swollen. She had a very high fever
with a bounding pulse. The skin was excessively hot to the
touch. Her whole person was as red as a coal of fire. She was
wild with delirium. I had a tub filled with water and lumps of
ice. Two sheets were put into it. The sisters stripped her and
applied one of these sheets to her person from her chin to her
feet. The steam rose from her in a cloud. She became quiet
immediately. But as soon as the sheet became warm she began
to rave again. The other sheet was then applied. This was
continued for an hour, when the fever subsided, and there was
no further trouble in her case.

Twenty-four of these girls did not take a dose of medicine
of any sort. They all recovered rapidly. I do not doubt but
that others of them would have been bad cases had they not
drunk the wine or toddy freely, and held the ice in their mouths.
I afterward treated one of my sons, then in his fifth year, in
the same way. When the wet towel around his throat would
begin to get warm, he would say, " Father, put the towel in the
ice, it makes me feel good when it is cold." He was soon
entirely well.

After this I saw three cases of diphtheria — children in the
same family. I was called in consultation. They were then in
the blue or congestive stage. The physician in attendance told
me they had gone very rapidly into this stage Like similar

.Calomel. 285

cases of scarlet fever, of Asiatic cholera, and of congestive fever,
the vital forces were too far overpowered for any thing to be
done.

I prescribe no medicinal drug. With a few exceptions there
are no specifics. There are other valuable cathartics besides
those which I have named. Among saline cathartics I consider
the salts made at Crab Orchard Springs, Kentucky, to be by far
the best. They contain other ingredients besides the sulphate of
magnesia. Dr. Robert Peter's analysis of these salts can be
found in the Geological Survey of Kentucky by Dr. David Dale
Owen. Opium, veratria, belladonna, aconite, and many other
articles of this class, are valuable ; but, for the most part, they
effect very little benefit, unless the secretions and excretions are
corrected, as explained in former chapters. The preparations of
iodine are also valuable; but they are too frequently given in
doses unnecessarily large. The medical journals are full of re-
ports of cases in which physicians appear to boast of the enor-
mous doses they give of this, that, or another drug; of any
thing, it would seem, except calomel. This applies particularly
to obstetrical cases, and especially to those in which puerperal
convulsions occur.

In these last, hundreds of women, in my opinion, have been
killed by chloroform and preparations of opium hyperdecmically
administered or otherwise. Dr. David Keller, of Paris, Ky.,
told me that he had found teaspoonful doses of calomel to relieve
puerperal convulsions in quite a number of cases. He has had
a large obstetrical practice, and has every confidence in the effi-
cacy of his remedy. I have had no experience in such cases
which is worth relating, but I have all confidence in Dr. Keller's
statements.

A once distinguished Kentucky physician. Dr. Lewis Mar-
shall, used to say that any man was a fool who required over two
hours two deliver a full course of lectures on obstetrics. He
was an extravagant man to talk; but he had particular reference
to the duties of the accoucheur, and meant that the woman's

286 Calomel ^

general health should be looked after beforehand, and that the
secretions and excretions should be properly regulated. When
this is done, very many troubles, some of them fatal, will be
avoided.

Mr. Abernethy acquired great fame in London, and it has
extended to the United States, by curing surgical troubles through
constitutional remedies. Nowadays in consequence of the scien-
tific (so-called) errors, which I have endeavored to expose, it is
too often the case that surgical methods are resorted to in the
removal of maladies which were more constitutional than local.
This applies particularly to gynecology and the lesions of the
urino-genital system, and also to diseases of the eye. There is
no department in the practice of medicine in which improve-
ments so great and beneficial have been made than in the mala-
adies just referred to. But in these cases too little attention is
often paid to the general health of the individual.

A gentleman applied to me a few years ago to treat his eyes.
I told him that I was surprised that he came to me for that pur-
pose; as I was satisfied that I would not have been as nearly
blind as I am had I been able to look at my own eyes. He said
his general health was out of sorts. He said he had been to con-
sult one of the most distinguished oculists in the United States,
who had told him it would be necessary to take out his left eye to
save his right one. This he was unwilling to submit to. I told
him that I would undertake to^ correct his general health. I
gave him pills composed of calomel, ipecac, aloes, and rhubarb,
in equal quantities. He took from six to ten grains of this mix-
ture every night or every other night. The improvement of his
general health was rapid. He said that all of his friends who
met him noticed it. His eyesight was also improved. Having
business in the city where the distinguished oculist lived, he
called to see him and his partner or assistant.

The distinguished oculist was abroad, but the other gentle-
man noticed the improvement, not only of his general health
but also of his eyes, and said, ^* We made a very great mistake
when we recommended that your left eye should be removed to

Calomel 287

save the right one. We would not take it out now for any con-
sideration/^

There are some maladies, cancer and syphilis for instance,
which seem to be compatible (for a time) with a moderate
amount of general good health; that is to say, the digestive
system is able to convert food into blood, and to sustain the
ordinary powers of life. This applies also, as is well known,
to cases of insanity, idiotcy, and imbecility. The asylums all
present cases in which, but for the troubles referred to, the indi-
viduals are physically well.

It is in this latter class of cases that medicines, which act
particularly upon the nervous system, are most valuable. But
they are too often given in such cases without sufficient attention
being paid to the secretions and excretions.

As to the use of mercury in the treatment of syphilis. Dr. E.
L. Keyes, of New York, says, "In 1874 Wilbouchewitch, mak-,
ing use of the microscope and a special instrument for blood-
counting, studied the blood of syphilitic hospital patients who
were taking mercury. He concluded from his observations that
small doses of mercury at first increased the number of red
cells in the blood, but, if long continued, produced the same
results as large doses in animals, namely, a diminution of the red
cells, diarrhea, etc.

" It is well known also that Grassi and Ricord, by chemical
methods, determined that the use of mercury early in syphilis
diminished the number of red cells relatively to the whole mass
of blood.

" Here, then, was the problem how to reconcile such seem-
ingly conflicting results arrived at from the same premises.

" The solution became easy when it was recognized that the
premises were not the same. Grassi did not even pretend to use
small doses of mercury, but pushed the drug to its toxic effect,
and then found that it was debilitating, a result which all must
admit.

"Wilbouchewitch also overdosed his patients, though to a
less degree, and he does not seem to be aware of it, although his

288 Calomel

patients lost weight and got diarrhea. Of his ten cases, five got
over one half grain of corrosive sublimate a day, the rest a grain
and a half of protoiodide; surely in neither case a very small
dose for a patient on hospital diet.

"My own experiments with the hematimeter, using minute
doses of mercury upon healthy and upon syphilitic individuals,
I think have proved beyond question, that mercury in minute
doses is tonic in all cases where it can be digested, in syphilis or
out of it, continued for a short or a long (over three years)
time.^'

I do not discredit Dr. Keyes's observations, but I would not
follow his practice. If mercury increases the number of red
cells in the blood it is not because, in my opinion, it is digested,
as Dr. Keyes expresses it, but because the general health has
been improved by the administration of the drug.

The mercury only removes the difficulties which obstructed
the generation of red cells. In that sense, and in that only, is
it a tonic. It is not a constituent part of the blood, as is iron.
Two of the most distinguished of German physicians, Drs. Nie-
meyer and Liebermeister, class mercury, I believe in all its
forms, among the antiseptics. I believe that scientific physicians
generally agree with them.

Now, if it is an antiseptic, I can not see how it can be classed
among digestible articles.

The German physicians, as well as all others in Christendom
who assume to call themselves scientific, adopt the theories of
M. Claude Bernard and Dr. J. Hughes Bennett, as to the func-
tions of the liver, and the sources and uses of the bile.

Denying that the bile is an excrementitious fluid, and also
denying that calomel has any power to excite or increase its
secretion in the liver, while they are bound to admit that pa-
tients are greatly benefited from its administration, they have to
account in some way for its therapeutical efficacy, and so they
call it an antiseptic.

I have not adopted the Little Bugs theory of disease; it may
be scientific, but it belongs too closely to the infinitesimals of

Calomel, 289

Hahnemann and to the problem of St. Thomas Aquinas, for my
comprehension.

I would not exclude the Little Bugs altogether, but as to the
origin of fevers, I rather agree with Dr. Daniel Vaughan. If
my views, as to constructive assimilation and destructive meta-
morphosis; as to the functions of the liver and the uses of the
bile; as to eifete matter; and as to the therapeutical efficacy of
calomel, are correct, then it will not be necessary to say that
mercury is digested or that it is an antiseptic.

I use iron in its various preparations in the treatment of dif-
ferent maladies. Having had ague-and-fever so much myself,
and having had a good deal of experience in the treatment of it,
I have paid particular attention to the best method of cure. I
have given my prescriptions to many physicians in Kentucky
and other states.

As I know that two men are selling my remedies under their
own name and for their own exclusive benefit in half a dozen
states on the Ohio and Mississippi rivers, I will here give them.
The first I call "ague pills or powders.'' They are composed of
prussiate of iron sixty grains, sulphate of quinine sixty grains,
capsicum thirty grains, soc. aloes thirty grains, arsenious acid
one grain, to be made into thirty pills or powders. I commence
from eight to ten hours before the expected chill and give a pill
or powder every hour till six doses are taken. This will almost
always prevent the chill or ague. On the next day I commence
at the sanne time and give a pill or powder once every two hours
until four doses are taken. On the third and all subsequent days
begin at the same time and give a pill or powder every three
hours until four doses are taken. I also use what I call cathartic
pills. They are composed of sulphate of iron twenty grains,
soc. aloes twenty grains, calomel twenty grains, to be made into
twelve pills. I give from one to two of these pills every night
or every other night until all are taken. If this course is fol-
lowed it will very rarely happen that there will be any recur-
rence of this troublesome malady.

Quinine is an antiperiodic, and will stop chills, but it will not

19

290 Calomel.

prevent their return, unless the secretions and excretions are
attended to. I do not believe in giving quinine in toxic doses.
Every physician who has had an extensive private practice knows
that a majority of the cases which he is called to see would
recover without medicine if carefully and properly nursed and
judiciously fed.

A little medicine may sometimes be given to such cases with
advantage. It satisfies the mind of the patient or of his friends,
and the individual will probably recover in a shorter time. It
is only the occasional case which demands the skill of the physi-
cian. What he thinks the case requires should be done promptly
and boldly.

When an individual faints, when he or she has an epileptic
fit, or is struck down by apoplexy, it is best to do nothing, except
to place the patient in a recumbent posture, to see that their
clothes are loosened, and that they have fresh air. The bold-
ness here necessary is to quiet alarmed and excited friends and
bystanders, and to prevent them from doing what might be
hurtful.

Sometimes a physician is called to a case. He examines the
patient carefully, and says " we must wait, there is nothing to be
done at present." It is no doubt the best advice. Sometimes he
is called to a case which requires a prompt and powerful remedy ;
then he should not hesitate to give or to use the remedy. To
know how and when to do this is what constitutes the good
physician. ,

Fevers and inflammations, and congestive affections, like chol-
era infantum and Asiatic cholera, kill a majority of the human
race ; and a very large proportion of that majority is among those
who were in good health at the time of their seizure — young men
in the prime and vigor of life, and young women in the bloom
and beauty of their loveliness. To know how to treat these acute
maladies successfully the physician must understand the prin-
ciples I have endeavored to explain in former chapters.

I have pulled down the temple of medical science erected by
the philosophers of the nineteenth century; but I am not an

Calomel 291

Erostratus; I have laid the foundation for a nobler and more
enduring temple in its stead.

Kepler explained the laws which govern the solar system. I
have undertaken to explain the laws which govern the animal
ecQUomy, both in health and in disease.

I acknowledge my obligations to Drs. Flint and Dalton —
copies of whose books I borrowed — for their learned works
on physiology. I cheerfully recommend these works to all med-
ical students, and to young physicians, for I am convinced that
a successful practice must depend upon a correct and thorough
knowledge of physiology.

Having concluded what I have to say on general principles,
the following and concluding chapters will be on chronic dis-
eases and Asiatic cholera.

292 Chronic Diseases,

CHAPTER XIV.

Chronic Diseases.

"Achilles' wrath, to Greece the direful spring of woes unnum-
bered/' did not send as many mortals beyond the Styx as have
false and absurd medical theories, which, in their day and gener-
ation, were supposed to be scientific. Boerhaave was the most
distinguished physician of his day ; so much so that the Emperor
of China consulted him. He was a man of great learning. His
theory abolished the use of cold water in Europe in the treat-
ment of fevers for over a century ; and many parts of Christen-
dom are to-day under its influence.

Thanks to Priessnitz, the people of Europe and the United
States now have a better knowledge of the value of cold water
in treatment of fevers and other maladies. I say, advisedly,
thanks to Priessnitz, because Dr. Currie's doctrines were never
known, or if known, were not understood when the hydropathic
system of the German peasant was established. And to-day both
the practice of Currie and Priessnitz are likely to go into disuse
because of another theory — viz. that high temperature, that is a
temperature above the standard of health, is the cause of death
in fever cases ; which cause has to be controlled by one of two
methods — viz. toxic doses of quinine, that is, from thirty to sixty
grains at a dose, or the immersion of the patient into a cold bath
every two hours, whether his teeth chatter or he shivers as if
from an ague or not.

I say this is the new theory, which is likely to abolish the
practice of both Currie and Priessnitz, among those physicians

Chronic Diseases, 293

who assume to call themselves scientific. The authors of this
theory give fanciful and imaginary explanations as to the cause
of the high temperature.

When Claude Bernard discovered, or supposed that he dis-
covered, that the particular and especial functions of the liver
were to produce or create sugar and fat; and when he, or some-
body else, thought that they had discovered that another function
of the liver was to form urea out of constituent parts of healthy
blood, then it was altogether unscientific for a medical man to
pay any attention to the bile-producing abilities of the liver.
Besides it had been discovered by scientific physiologists that
the bile was not an excrementitious substance ; but that it was
incrementitious, and that it was all reabsorbed except the cho-
lesterin.

The logic of science forced physicians, who assume to be
learned, to the conclusion that medicines called cholagogues were
altogether useless, if not injurious. Hence the Surgeon-general
of the United States Army, who is to-day one of the most
learned and distinguished physicians in the city of New York,
ordered, or attempted to order, that mercury in all its forms,
and particularly calomel, should be excluded from the medical
army-chests during our late tremendous war. I say tremendous
war, for there were over four millions of men engaged in it.

Had any severe epidemic attacked either the Federal or Con-
federate armies (and it is a remarkable fact that no epidemic
attacked either, though the war lasted over four years), and had
Dr. Hammond's scientific order been carried out, it is more than
probable that science would have killed many more Federal
soldiers than did the rebel cannon-balls and bullets.

After this came the report of Dr. J. Hughes Bennett. Had
the Surgeon-general of the United States Army had this report on
which to stand, nothing less than the common sense of President
Lincoln could have prevented the exclusion of calomel from the
medical army-chests; for every medical man within the Federal
lines, who pretended to be scientific, would have fully sustained-
Dr. Hammond.

294 Chroyiic Diseases.

It is perfectly marvelous how few men think for themselves.

The practice of medicine never was at any period of the
world's history more thoroughly empirical than it is to-day. I
do not refer to the practice of surgery. Thanks to John Hunter,
that is better understood.

The medical schools teach no principles which their students
can understand, hence they have to follow authorities.

While the theories of Claude Bernard and J. Hughes Bennett
were considered to be demonstrated science, a young physician
just from Philadelphia, New York, London, or Paris, would as
soon have thought of looking into the palm of the hand to tell
the condition of his patient as to look at the stools.

But another authority has loomed up. I refer to Charles
Murchison, M. D., LL. T>., F. R. S. He is a distinguished Lon-
don practitioner; and is no doubt deservedly distinguished. His
work on the Functional Derangements of the Liver could not
have appeared at a better time.

The people throughout this country and Europe still continue
to discover, as often as they are sick, that a dose of calomel or
blue-mass does relieve them of their ailments, science to the con-
trary notwithstanding; and they so tell their medical practition-
ers or family physicians.

But as these common people know nothing about science, let
their feelings tell them what they might, the learned physicians
required an authority, and Dr. Murchison came to their rescue ;
though many physicians still cling to science, let popular experi-
ence tell what it may. Dr. Murchison thus explains the case :

" Cholagogues. — Among these remedies mercury and its prep-
arations hold a preeminent place. At the present day mercury
has lost much of its former reputation as a cholagogue and alter-
ative, and there is much difference of opinion as to its power
over the liver. The practical physician gives a dose of calomel,
finds the quantity of bile in the motions greatly increased, and
his patient's state much improved ; and he argues that the liver
has been stimulated by the mercury to an increased secretion of
bile, and that to this cause his patient's improvement must be

Chronic Diseases. 295

ascribed. The physiologist, on the other hand, ties the common
bile-duct in one of the lower animals, produces a fistulous open-
ing into the gall-bladder, and then finds that calomel has no
effect on, if it does not diminish, the amount of bile that drains
away through the fistula. It may interest some who are present
if I refer briefly to the principal of these experiments.

"Kolliker and Muller, in 1855, tried the effects of calomel
upon the secretion of bile in a dog with a biliary fistula. The
results were somewhat contradictory.

"Once the bile seemed to be increased, and twice it seemed
to be diminished by the administration of calomel.

"Of four experiments made in 1858 on a dog with a biliary
fistula. Dr. George Scott found that in all the administration of
large doses of calomel was followed by a diminution of fluid
bile and of bile solids.

"In the same year (1858) Dr. Mosler made similar experi-
ments upon two dogs with biliary fistula. The administration
of calomel was not followed by any increase of bile, nor could
mercury be detected in the biliary secretion.

"Ten years later (1868) a committee of the British Medical
Association, with Professor Hughes Bennett, of Edinburgh, as
chairman, made a number of similar experiments on dogs, and
came to the conclusion that mercury did not increase the flow of
bile, but rather diminished it.

"Next in order (1873) came the experiments of Dr. Kohrig,
of Kreuznach, made in the Pathological Institute of Vienna.
He found that although large doses of calomel did seem to in-
crease somewhat the secretion of bile, its power to do so was
inferior to croton oil, colocynth, jalap, aloes, rhubarb, senna, and
sulphate of magnesia, the cholagogue power of these drugs di-
minishing very much in the order in which they have now
been enumerated, and calomel standing at the bottom of the
scale.

"The most recent experiments are those of Professor Ruther-
ford and M. Vignal, on four different dogs during fasting. In
three the secretion of bile was diminished, and in one it was

296 ChroniG Diseases.

ascertained that not only 'the total quantity, but the percentage
of solids, was reduced. In the fourth case the quantity of bile
was increased, but there were reasons for believing that the
increase was not due to the calomel.

"The results of experiments upon the lower animals have
added greatly to the discredit previously thrown upon mercury
by its failure, when brought to the test of accurate clinical obser-
vation, to absorb plastic lymph in most forms of inflammation;
and some eminent physicians are even of the opinion that mer-
cury and its preparations ought to be erased from our pharma-
copeia. On the other hand, it has been fairly objected that the
results of experiments with mercury upon dogs do not warrant
conclusions as to its effects upon man ; and even granting that in
man mercury does not increase the quantity of bile secreted by
the liver in health, it does not follow that in disease there may
not be some condition adverse to the formation of bile which
mercury may have the power of removing. Much, however, of
the difference of opinion between physiologists and the practical
physician may be reconciled by keeping in mind the osmotic cir-
culation, to which I referred in my first lecture (p. 38), as con-
stantly going on between the intestinal contents and the blood.
A large part of the bile secreted by the liver and thrown into the
bowel is constantly being reabsorbed to reach th*e liver again;
and accordingly when the common bile-duct is tied and a fistu-
lous opening into the gall-bladder established, the quantity of
bile which escapes through the fistulous opening immediately
after the operation is much greater than at any time subsequently
(Schiff). Mercury and allied purgatives produce bilious stools
by irritating the upper part of the bowel and sweeping on the
bile before there is time for its reabsorption.

" The fact of mercury standing at the bottom of the scale of
cholagogues in Rohrig's experiments is accounted for by its sur-
passing other cholagogues in this property; for of course the
larger the quantity of bile that is swept down the bowel, the less
is reabsorbed, and the less escapes from a biliary fistula. That
mercury does act especially upon the duodenum, is proved not

Chronic Diseases. 297

merely by the large flow of bile which follows its action, but by
the fact discovered by Kadziejewski, that leucin and tyrosin,
which are products of pancreatic digestion, under ordinary cir-
cumstances decomposed in the bowel, appear in the feces after
the administration of mercurials. It would appear then that
mercury, by increasing the elimination of bile and lessening the
amount of bile and of other products of disintegrated albumen
circulating with it in the portal blood, is, after all, a true chola-
gogue, relieving a loaded liver far more effectually than if it
acted merely by stimulating the liver to increased secretion, as
was formerly believed, and as some authorities still maintain ; for
in this case it might be expected to increase, instead of diminish,
hepatic congestion. It is not impossible also that the irritation of
the duodenum by calomel and other purgatives may be reflected
by the gall-bladder, and cause it to contract and discharge its
contents, and thus account in part for the increased quantity of
bile in the stools.

'^ There are likewise, I believe, grounds for believing that
apart from its increasing the discharge of bile from the bowel,
mercury exerts a beneficial action in many functional derange-
ments of the liver, in whatever way this is to be explained.
Patients of the greatest intelligence suffering from hepatic dis-
orders constantly declare that they derive benefit from occasional
or repeated doses of mercurials which no other medicine or treat-
ment confers; and the skepticism of the most doubting physi-
cian would, I believe, be removed should he unfortunately find
it necessary to test the truth of their statements in his own per-
son." (Pages 175 to 180.)

Dr. Murchison's work is really valuable in the practice which
he prescribes ; though he holds on to science with a full hand and
firm grasp, while he touches daily observations and practical expe-
rience with the tips of the fingers of his other hand ; and even
then he has to call in osmosis and exosmosis to relieve him of
the dilemma. He teaches that the bile is partly excrementitious ;
though, as he admits, physiological science denies the fact.

298 Chronic Diseases.

As to the method by which mercury acts, he says, " It is not
impossible that the good effects of mercury on the liver, and in
some forms of inflammation, may be due to its property of pro-
moting disintegration. Mercury appears to have the power of
rendering effused fibrin less cohesive and more easily removed
by absorption than it otherwise would be."

Among the chronic diseases for which he prescribes calomel
or blue-mass, I will mention lithemia and the various forms of
dyspepsia, with which it is very often associated. He says :

" From what has been already stated, it is clear that the kid-
neys and the liver are intimately connected in their functions, the
main object of the kidneys being to eliminate certain products
which are in great part secreted in the liver."

He speaks of "diseases and symptoms resulting from the
abnormal disintegration of albuminous matter in the liver";
and of fibrin he says, " It is not improbable that the large quan-
tity of fibrin found in the blood of acute rheumatism may result
from fibrin not being destroyed in the liver to the proper extent."

Again he says :

'^Pyrexia. — The liver is one of the few parts of the body
which does not waste during the fever. On the contrary, it
becomes enlarged and congested, while its gland-cells are swollen
out with minute albuminous glanules ; and it is well known that
these changes are attended by an increased disintegration of
albuminous matter and an increased production of urea and less
oxidized products."

It will be clearly seen from these last quotations, that Dr.
Murchison teaches that urea and other less oxidized products
are created in the liver; and that it is a special function of the
kidneys to remove these products; and that when other less
oxidized products than urea are formed in the liver, then more
difficult work is thrown upon the kidneys.

I do not intend again to go over what I have so extensively
discussed as to the relation between the liver and kidneys in
former chapters; but I must call the attention of the reader to
the consideration of some facts which always occur in chronic

Chronic Diseases, 299

diseases, and which facts have particular reference to the func-
tions of the liver in pathological states of the system.

If I understand Dr. Murchison and other physiologists, they
all teach that the bile is formed from disintegrated albumen and,
perhaps, fibrin. These are constituent parts of pure blood.

I have before spoken of the lungs and liver being compensa-
tory organs.

The pulmonary artery conveys from the right side of the
heart to the lungs, not only the venous blood proper, but also a
large amount of lymph, which is poured into the descending
vena cava from the thoracic duct. The pulmonary veins convey
to the left side of the heart a smaller quantity of fluid, called
blood, than is carried to the lungs by the pulmonary artery.
It is minus the quantity of carbonic acid and watery vapor ex-
pired. These are unquestionably excrementitious.

Now it is also known that the hepatic veins convey to the
vena cava a smaller quantity of blood than is brought to the
liver by the great portal vein and the hepatic artery. It is
minus the bile which was separated from the fluid, called blood,
passing through the liver.

Now physiologists teach that the bile is all reabsorbed except
the cholesterin; and that this is a constant fact. If they are
correct, I demand that they shall explain why less blood flows
from the liver than enters it. If a boy takes a bag of corn to
mill, he gets a quantity of meal minus the toll taken out by
the miller. Now, if the miller pours the toll back into the hop-
per, why does not the boy get all the meal which the corn could
make ? The bile is the toll taken from the blood by the liver.
I maintain that it is altogether and entirely excrementitious ; as
much so as the carbonic acid and the watery vapor thrown off
from the lungs. I have said that constructive assimilation and
destructive metamorphosis, or the separation of effete matter
from the living organized tissues, do not go on in an animal
body at one and the same time; and that, in a state of perfect
health, the separation of effete matter from the living tissues
does not occur at all. But I teach that this separation of effete

300 Chronie Diseases,

matter does occur in all acute diseases, of any duration; and
that it always occurs in chronic diseases, except those (like some
forms of insanity) in which vegetative or organic functions are
not disturbed. It does occur in all of those forms of disease
treated of by Dr. Murchison in his recent work.

Let us now consider the character of the fluid which courses
through the great portal vein on its way to the liver. It has three
distinct characters, all unlike each other. The first is the food,
under its several forms, which is absorbed by the veins from the
stomach and intestines. That portion of it is mixed up with the
saliva, the gastric, the pancreatic, and the intestinal juices.

The second form is composed of blood returning from all the
abdominal organs. Arterial blood was carried to those organs,
and it parted with what went to make up the gastric, pancreatic,
and intestinal juices. This venous blood, then, is to that extent
effete. But in these pathological states the capillary vessels take
up from the living tissues effete matter, the product of destruc-
tive metamorphosis. This effete matter is emptied into the veins,
which return it to the liver, and they are to that extent filled
with effete matter.

Now the third constituent part of the fluid found in the great
portal vein is, in health, rejuvenated blood; that is, an increased
quantity of fibrin, and albumen, and white blood corpuscles,
coming from the spleen. This, however, does not occur in dis-
eased conditions to any extent, and often not at all.

I will remark here, in passing, that physiologists have found
a much larger number of white blood corpuscles in the blood of
the hepatic veins than in the great portal vein. Their inference,
it appears to me, is that these white corpuscles are formed in the
liver. I do not say that the liver does not help to perfect them,
but they have overlooked the fact that the hepatic veins convey a
much smaller quantity of blood to the vena cava than is brought
to the liver l)y the great portal vein, not to speak of the hepatic
artery. But this is a digression.

Now let the reader consider well that no physiologist denies
that in the pathological conditions referred to a very ' large

Chronic Diseases. 301

amount of effete matter is carried to the liver. And let the
reader also remember that physiologists all teach that effete mat-
ter, let it be formed however it may, is excrementitious.

Now, I ask, why is this excrementitious effete matter carried
to the liver? Something, we know, is separated from the blood
passing through the liver ; that is, two pounds and a half of bile
in a man weighing one hundred and fifty pounds every twenty-
four hours. Physiologists all teach that this excrementitious
effete matter passes through the liver untouched; that is, it is
not separated from the blood, and that it goes to the kidneys to
be eliminated from the blood by them.

They teach, I know, that urea and other oxidized products
are formed in the liver, but they do not say that they are formed
from effete matter. Indeed they deny it, and maintain that urea
and other products are formed from disintegrated albumen and
fibrin. They do not say that this disintegrated albumen and
fibrin are parts of the effete matter brought to the liver. I
teach that all the effete matter brought to the liver is always
converted into bile when the liver is able to perform its func-
tions healthfully ; and as this bile is formed out of effete matter,
it is necessarily excrementitious.

But when the functions of the liver are not healthfully per-
formed, when the effete matter is not all converted into bile,
then, and only then, a part of it passes to the vena cava through
the hepatic veins, and extra work is thrown upon the kidneys as
well as upon the lungs and skin.

There are certain pathological states, of which Asiatic cholera
is the fullest expression, in which the functions of the liver are
suspended, and the effete matter passes through that gland un-
changed. Other pathological states approximate this. In all
of these conditions mercury is the efficient remedy. Explain
it as you may, it removes the morbid conditions.

This is my explanation of the value of calomel and blue-mass
in the treatment of chronic diseases. But I do not confine
myself to these two drugs.

Ipecac, aloes, rhubarb, and colocynth are all valuable in the

302 Chronic Diseases,

treatment of the majority of such affections. Besides the saline
cathartics, particularly Crab Orchard Salts, often give prompt
and permanent relief. I do not exclude other remedies, but if
a physician would use any one of them properly, he should
know why he should use them, otherwise he will practice em-
pirically.

Now I maintain that I have explained the principles upon
which a rational practice is founded. But in this consideration
we must not overlook Dr. Cooke's theory of congestion, which
occurs in so many chronic maladies.

When the kidneys are at fault, and the states of the urine are
morbid, we must bear in mind that the renal veins have no
valves, and that the congestion of the vena cava and its
branches also directly affects those glands. It must also be
borne in mind, that the renal veins enter the vena cava below
the mouths of the hepatic veins, and that when the urea formed
in the kidneys does not all pass through the ureters into the
bladder, then that this urea may, and does, pass through the
renal veins into the vena cava.

This is a pathological state, and explains why urea is found
under such conditions in the blood of the general circulation.
It never occurs in a state of perfect health.

To relieve, then, lithemia, and many forms of dyspepsia
which are associated with it, we must see to it that the liver
performs its functions healthfully.

Dr. Murchison very correctly says, that this can often be bet-
ter effected by a proper system of diet, including both food and
drinks, than by any other method. Outdoor exercise, often
horseback exercise, contributes greatly to this end.

Maladies affecting the brain and nervous system; maladies
affecting the urinary and genital organs; and particularly mala-
dies peculiar to women, are all to be treated upon the same
principles.

From my very limited knowledge of the use of the micro-
scope and of chemical analysis — in a word, of histology — I do
not doubt that they are one and both of great value in making

Chronic Diseases, 303

out a correct diagnosis. But, in my opinion, too much impor-
tance is attached to them at this time, because the conclusions
arrived at are not sufficiently definite and positive.

From discussions which are published in medical journals
it is manifest that these so-called sciences are but yet in their
infancy.

The Scribes and Pharisees paid tithes of mint, anise, and
cummin, but omitted the weightier matters of the law. We
should not follow their example.

304 Cholera,

CHAPTEE XV.

Cholera.

The Abbe Hue, in his journey through the Chinese empire,
gives the following graphic account of the majestic and awful
phenomena which heralded the first appearance of cholera in that
counliry. He says, ^^ We have the account from a great number
of the inhabitants of the province of Shan-Tung who were eye-
witnesses of what they related. In the first year of the reign
of the deceased Emperor — that is to say, in the year 1820 — a mass
of reddish vapor was noticed one day upon the surface of the
Yellow Sea. This singular phenomenon was observed by the
Chinese of the province of Shan-Tung, which forms its coast.
The vapors were at first light, but gradually increased, became
condensed, rose little by little above the surface of the water,
and at last formed an immense red cloud, which remained for
several hours floating in the air. The Chinese were seized with
terror, as they mostly are in the presence of all great natural
phenomena, and sought in certain superstitious practices of the
bonzes the means of averting the threatened calamity."

"While the inhabitants of Shan-Tung were seeking to conjure
away this unknown misfortune, which yet every one foresaw, a
violent wind suddenly began to blow, and, dividing the cloud
into various columns, drove them on toward the land. These
red vapors spread in a winding course along the hills and valleys,
and swept over the towns and villages, and wherever they passed
men found themselves suddenly attacked by a frightful disease.

Cholera. 305

which in a moment deranged the entire organization, and changed
a living man into a hideous corpse."

I do not know that we know any thing more about the cause
of cholera to-day than did the Chinese when the Abbe Hue vis-
ited them. He says that it ste-uck on all, rich and poor, young
and old, sometimes on one side and sometimes on the other, but
always apparently in the most capricious manner without follow-
ing any fixed rule in the midst of its fearful ravages. It ravaged
first the province of Shan-Tung, then turned northward to Pekin,
striking always in its march the most populous towns. It is not
my purpose to give the history of cholera. There may be said
to be two theories as to the origin of cholera in different years
and in localities widely separated. The one is that it is carried
along the great thoroughfares of travel ; the other is that it is of
local origin, let it appear where it n^ay.

Those who maintain that it is of local origin say that it is
produced or caused by malaria, miasm, or the decomposition of
animal or vegetable matter, particularly of the latter. Dr. John
Esten Cooke and Dr. Theodore S. Bell are among the most distin-
guished American physicians who believe in the malarial origin
of cholera. I can not agree with these distinguished writers. I
have referred to the tide- water region of Virginia. It is a sand-
stone country, with soft spring-water. Miasmatic or malarial
fevers prevail in that region with the regularity of the summer
and autumnal seasons, and yet, so far as I have been able to
inform myself, the cholera has never appeared in that portion of
Virginia, except in the larger towns, as Richmond, Petersburg,
and Norfolk. I believe the same to be true of Maryland, North
and South Carolina, and Florida. If malaria was the only cause
of cholera, it certainly ought sometimes to have appeared among
the farming community living on the rivers which empty into
the Chesapeake Bay. That accumulated filth and stagnant pools
of water may aggravate the disease and make it more fatal in
localities where cholera prevails, I have no doubt; that the
drinking of bad water is often the proximate cause of the attack
I have also as little doubt. When I come to explain what I

20

306 Cholera,

understand to be the pathology of cholera and the distinguishing
features of that malady, I think I will be able to show more con-
clusively that it is not of miasmatic or malarial origin.

Dr. Charles Caldwell says, ^^ We believe the complaint to be
not contagious, but a true epideaiic, subject to the laws which
govern other diseases of the same class. Like all other epidem-
ics, it travels much more rapidly than any complaint simply con-
tagious can do, its march being sometimes from fifteen to eight-
een miles a day. Within the last fourteen years it has overrun
a greater extent of the surface of the globe than the smallpox
has ever done in a century. It banishes from the place where it
prevails all other general diseases, or assimilates them to itself.
Neither typhus fever, bilious fever, nor even pestis vera can exist
in their common forms within its limits. The reason is obvious.
It has possession of the atmosphere, and is therefore supreme.
This is another law of genuine epidemics.'^ (Transylvania Med-
ical Journal for 1831.)

In my opinion all quarantine laws are utterly powerless to
prevent the appearance of cholera in any city, town, or place.
The all-important thing to know about cholera is, what is the
nature of the disease, or what are the conditions of the malady
to be prevented, or to be relieved ; and the second equally impor-
tant thing is to know how to cure it. Let us first endeavor to
understand the nature of the disease. Before we undertake to
do this let us ask ourselves, Is cholera a curable disease? The
professor of the theory and practice of medicine in the Medical
Department of the Louisville University, Dr. T. S. Bell, says that
it is not. The Abbe Hue informs us that the Chinese entertained
the same opinion fifty years ago.

Dr. John Mackintosh treated cholera when it first appeared
and prevailed in Edinburgh. He had charge of the Drummond-
street Hospital, into which establishment there were received
four hundred and sixty-one patients, of which number two hun-
dred and ninety-one died ; of these two hundred and eighty were
examined most minutely to ascertain the cause of death.

" The morbid appearances peculiar to cholera observed in those

Cholera. 307

persons who died in the collapsed stage. — The blood attracted our
attention in the first dissection, and it had the same appearances
to the last. It was dark colored, and had lost much of its fluid-
ity; this was expected, from the accounts that had previously
reached us from other countries. But we were astonished to
find that it was contained in the arteries and veins, in the most
minute capillary, as well as in the larger vessels ; that it had the
same dark color in both sets of vessels, some of them containing
a small quantity, others being enormously distended. The capil-
laries and large veins on the surface of the body contained as
much blood after death as during life. On opening a vein in
the dead body, the blood flowed almost as readily as it had done
during life in the same person. The surface, therefore, retained
the same dark appearance as it presented during life, and the
muscles were of a dark-red color. In the act of death, or im-
mediately afterward, in all other diseases, the blood leaves the
capillaries, recedes from the surface, and collects in the heart and
large veins near it; the arterial system is generally quite empty,
but occasionally a little blood is found in the aorta. Here are
at once observed three remarkable facts: First, an alteration
in the appearance and consistence of the vital fluid; second, a
change in its distribution; third, blood can be drawn from a
vein almost as readily after death as during life; and the im-
portant circumstance may be noticed, that there was an appear-
ance every where of an abundance of blood. Every incision
that was made, even in parts not depending, occasioned a flow
of blood, so as often to be troublesome by impeding our exami-
nations. Some thought the blood oily.

" In the Head. — Great vascularity was observed on the sur-
face of the brain and in the membranes; not only were the
capillaries injected, but the trunks of both arteries and veins
were filled with blood — the vertebrals, carotids, and circle of
Willis, as well as the vena Galeni, and the longitudinal and late-
ral sinuses. In the longitudinal and lateral sinuses, however,
the blood was not always in a semi-fluid state, but often coagu-
lated ; and sometimes there was a fibrinous clot extending through

308 Cholera,

the course of the sinuses of the brain, into the jugular veins.
This appearance of fibrin was observed also in those who died
in the consecutive fever. On the lateral surfaces of the hemi-
spheres of the brain we frequently observed an extensive ecchy-
motic patch ; sometimes there were several patches of this kind.
This appearance was produced by an effusion of bloody serum
between the arachnoid and pia mater. The injection on the sur-
face of the brain was more florid than that in any other part of
the body. The ecchymotic spot occupied in some cases only
about an inch and one half in length; in others it was very
extensive, involving the whole of the hemispheres, and occa-
sionally extending down between them. The vessels of the pia
mater, the velum interpositum, the plexus choroides, and the lin-
ing membrane of the ventricles, were injected. The surface of
the fourth ventricle, in general so white, was seen vascular, oc-
casionally slightly stained with blood. The ventricles, whenever
they were examined with a view of ascertaining the point, were
found to contain a considerable, sometimes a large, quantity of
serum. Sections of the brain displayed the cortical substance
much darker than usual, and the brain generally exceedingly
vascular. As sqpn as a section was made there immediately
appeared numerous large drops of blood, in size and number
much greater than is observed in other diseases, even in active
inflammation of the brain. In above one hundred and fifty
cases, the spinal marrow and its membranes were minutely ex-
amined. In all there was a very considerable quantity of
serum, the membranes highly injected, the rachidian veins
gorged with dark-colored blood, and the substance of the spi-
nal marrow, in a few cases, appeared a little softer in texture
than natural. In a large number of subjects there were ossific
depositions, in the form of scales, seen on the arachnoid surface;
occasionally they were very numerous and large. The general
practice was to place the subject on the face as soon as death
occurred, with a view of preventing engorgement of the spinal
marrow and brain from a depending position.

^'In the Thorax, — The lungs were found gorged with dark,

Cholera, 309

viscid, oily-looking blood; they were heavier than natural, in
some instances weighing three pounds nine ounces. Pleura
minutely injected; in those who died rapidly, both the pleura
and pericardium had a dry appearance ; in other cases the pleura
had an unctions feel, also the serous surface of the pericardium
and heart. Ecchymotic spots, of the form and size of patechise,
were frequently seen on the pleura costalis and pulmonalis, ex-
tending in many instances a line or two into the substance of
the lungs. Occasionally, in those who died in this stage, there
were seen one, or perhaps two, small portions of the lung indu-
rated and stained of a dark-red color, presenting all the charac-
teristics of ^pulmonary apoplexy;' this appearance, however,
was more frequent in those who died in the consecutive fever.
The bronchial membrane was injected, the tubes occasionally
gorged with mucus of various degrees of tenacity and tinges
of color; the surface of the heart and large vessels very vas-
cular, presenting many ecchymotic spots, more particularly on
the acute margin of the right ventricle and the aorta. In many
instances these were found to extend deep into the subjacent
tissues. On making sections, to display the cavities of the heart,
the left ventricle was almost invariably found in the state of
hypertrophy, with diminution of the cavity, and generally
empty. In the right auricle and ventricle there was found
a fibrinous clot, sometimes white, like coagulable lymph, at
others stained with blood, consisting partly of lymph and co-
agulated blood of a dark color. When a mass of lymph was
found in the right auricle and ventricle, it invariably extended
into the pulmonary artery, and in many cases could be traced
into the smallest ramifications; and sometimes the pulmonary
veins had a similar plug. On several occasions, the auriculo-
ventricular opening was closed by the plug, prolongations from
which were found interlacing between the columnse carnse and
cordfe tendinse. In the inner surface of the aorta, and in a few
cases in the pulmonary artery also, there was seen a distinct false
membrane, completely covering the inner membrane, and ex-
tending into the vessels that are given off from it; this membrane

310 Cholera,

did not always seem to be of recent date, but in many of the dis-
sections it was observed in an incipient state. It was most com-
pletely formed near the heart; and on some occasions it was
seen below the arch of the aorta, in the act of forming, present-
ing an appearance like tenacious mucilage, continuous with the
.portion already organized. Occasionally it was tinged of a
dark, sometimes of a bright-red color; but generally it was
white, and easily separated from the proper lining membrane,
even with the handle of the scalpel. In the few cases in which
it was found in the pulmonary artery, it was thinner and not so
completely organized. In the aorta, we frequently traced it to
the bifurcation of the iliacs; sometimes half way from the
heart, perfectly organized, the rest being in a gelatinous state.
When separated, the proper shining, smooth character of the
inner membrane was seen beyond all doubt, except at parts
where there were atheromatous depositions, which were some-
times confined to the false membrane, at others extended into
the proper coats of the artery. We carefully removed the con-
tents of the thorax, not only with a view of submitting them to
minute examination, but also to investigate into the condition of
certain nerves and ganglions.

"I shall now show the state in which we found the pneu-
mogastrics, phrenics, splanchnics, and similunar ganglia. The
dissection of the neck showed minute injection of the large ves-
sels, both sets containing dark-colored blood, more particularly
the veins, which were often not only full but distended.

"TAe pneumogastric nerve was frequently seen stained of a dark-
red color through its whole course in the neck and thorax. Some-
times there was merely vascularity on its surface, till it crossed
over the subclavian artery, where, in many cases, it was enlarged
so as to resemble a ganglion. This enlargement was always of a
bright-purple color, and existed on the right side only. But the
nerve was frequently similarly tinged at this point through its
whole substance, when there was no enlargement. On tracing
these nerves onward in their course, they frequently presented a
red appearance.

Cholera. 311

*'The phrenics, as they passed over the pericardium, were
observed to partake of the general injection; and when the
pericardium presented a half-dried appearance these nerves were
similarly affected.

^' In a great many cases we carefully traced the splanchnics on
both sides of the spine to the semilunar ganglia. In this part
of the thorax there was minute injection of the vessels, ecchy-
motic specs, like petechise. These nerves were implicated in the
injection on their surface, but in two subjects only was there any
discoloration or other mark of disease in the substance. In one
or two cases it was thought the ganglia were somewhat changed
from the natural color, but we discovered our error, having had,
at that period, several opportunities of examining these ganglia
in persons who died of other diseases, when a similar appearance
was seen.

^^ Abdominal Organs. — In the stomach, in two or three cases,
we found a considerable quantity of undigested food that had
been eaten a few hours before the attack, and on one occasion a
number of small stones, pieces of slate, and tiles. In some cases
there was considerable injection of the peritoneal surface of the
viscera, but this was by no means frequent. The stomach was, in
general, contracted, sometimes remarkably so, and several times
divided by contraction, in the center, into two cavities. The intes-
tines contained more or less of a matter similar to that vomited
during life. Unless the patient lingered long in the second stage
no appearance of bile was seen in the bowels. The mucous
membrane of the stomach was occasionally, but not always, vas-
cular; sometimes quite white, but almost always much softer than
natural, and in many cases thickened and quite pulpy, so as to be
removed with the slightest touch of the handle of the scalpel.
The mucous membrane of the intestines was, in general, more
vascular than that of the stomach, sometimes more minutely
injected than if size and vermilion had .been thrown into the
vessels. Occasionally there was ecchymosis, and frequently soft-
ening of the mucous membrane, sometimes ulceration, particu-
larly in the ilium and colon. The mucous follicles were gener-

312 Cholera,

ally enlarged, and Peyer^s patches, so rarely seen in adult age,
were seldom wanting; they were large, elevated, soft, and spongy,
and sometimes slightly ulcerated. In many cases we found the
colon, and sometimes the ilium, thickened, the mucous membrane •
soft, dark colored, and disorganized, as in some of the worst
forms of dysentery. The liver was frequently diseased, and the
disease not of recent date. Occasionally this organ was very
vascular, and we rarely missed seeing sufficient quantity of bile
in the pori. In two instances only were there such appearances
of engorgement as are described by the India writers. The gall-
bladder was, in every instance, filled; sometimes distended with
dark-colored and somewhat viscid bile, the organ itself being
very vascular, and in many instances containing gall-stones. In
no instance, save one, did we discover any impediment in the
passage of bile througli the ducts into the duodenum. In that
solitary instance a spherical-shaped calculus obstructed the' pas-
sage. The kidneys were generally diseased. The disorganiza-
tion described by Dr. Bright was very frequently met with. The
vessels of these organs were almost uniformly highly injected — a
puriform fluid was always found in the papillae ; the bladder was
always contracted, so as to be as small and dense as a virgin
uterus.'' (Mackintosh's Practice, vol. 1, pp. 387, 388.)

By reference to a former chapter in this book the reader will
find a notice of the discovery of valves in the veins by Fabricius,
the master of Harvey, to whom he demonstrated his discovery.

"Harvey observed the knots in the veins of the arm when a
ligature is applied, as for phlebotomy, and showed that the spaces
between these knots, which are formed by the valves, could be
emptied of blood by pressing toward the heart, and would not
fill with blood whilst the finger was kept at the lower extremity.
It was impossible by pressure with the fingers to force the blood
back through one of the valves." This is the condition of the
valves in the veins in Health.

By reference to the extracts from Dr. Cooke's work, para-
graph 1244, chapter 9, the reader will find the following as to
the condition of the valves : " It was, when thus laid open to

Cholera, 313

view, at a single glance apparent that the right side of the heart,
the cava, the subclavian veins, the iliac, the crural, and the deep
vein running along with the femoral artery down as far as the
calf, were very full of black blood. The veins were so full as to
preserve the round shape, and were stuffed full to the valves near
the head of the humerus, at which point the stuffed appearance
ceased suddenly; and immediately at the termination the vein
returning from the arm was empty, flaccid, and transparent, so
as to scarce be perceived by candle-light. On pressing the blood
of the full venous cavity toward the stuffed end at the head of
the humerus it would not pass into the vein beyond the valves;
but on increasing the pressure it was forced out of the minute
veins entering into the subclavian from the skin and other neigh-
boring parts, which had been cut across in laying bare the sub-
clavian vein, and whicb were so minute as not to let the blood
pass till pressure was made."

The reader will observe that in the body of this dissected
child the valves and the veins could not be forced to give way
even when great pressure was made upon the large and exposed
venous trunks. It shows clearly that these valves prevent the
blood from returning into the veins, where they exist even after
death.

I will call the attention of the reader to the facts observed by
Dr. Mackintosh, that the blood was less fluid than usual, and that
there was a large quantity of serum in the sinuses of the brain
and in the spinal column. He will also observe that there was
an unusually large amount of congested lymph in the heart and
larger blood-vessels.

I stated in a former chapter that I would have occasion to
notice the fact that there are valves in the lymphatic vessels. It
would seem, according to the dissections of Dr. Mackintosh, that
the lymphatic vessels had all emptied themselves into the tho-
racic duct and into the right side of the heart. The condition of
the blood and of the veins and arteries presented by these dis-
sections show that the valves have entirely lost their vital or nat-
ural power. What was the condition of things which forced

314 • Cholera.

them to give way ? It was discovered by the first anatomists who
made post-mortem examinations that the arteries were empty
in every part of the body, while the veins in the three cavities
of the skull, chest, and abdomen were found filled with blood.
The dissections of cholera subjects made by Dr. Mackintosh were
the first, so' far as I know, to present an equal fullness of the
arteries and veins, and particularly of the external veins which
have valves in them. Dr. Mackintosh represents the condition
of things which preceded death in these subjects as follows:

He says, "The duration of the premonitory or first stage is
various ; sometimes the unpleasant symptoms suddenly cease and
the patients recover quickly; but this happy issue is compara-
tively rare when proper remedies are not used; and in some few
cases, from the peculiarity of the constitution of the patient,
remedies seem to have little effect in arresting the progress of
the disease, even when applied in this early stage. The stools,
which were at first feculent and bilious, now become characteristic
of the true Asiatic cholera. They have the appearance of very
thin gruel, or rice-water; sometimes they are watery, limpid,
with small flakes of curdy-looking matter intermixed ; at other
times they present an appearance of water in which fresh beef
had been macerated. The usual feculent smell has vanished,
instead of which the stools have a peculiar odor, which struck
me to resemble that produced by macerating fish in water; a
similar odor is generally observed from the surface of the body.
More rarely the stools look like the lees of port wine ; and it was
remarked that almost none recovered who passed "port wine
stools." I recollect at present one recovery only in which there
was this appearance — it was the case of Field, who was saved by
saline injection into the circulation. The desire to go to stool is
irresistible and instantaneous; tenesmus is great in some cases,
sometimes preceded or accompanied by a sense of heat or griping.
The stools are generally very copious — sometimes, however,
scanty ; often accompanied by loud discharges of flatus from the
bowels. Along with the bowel complaint there is burning heat
in the region of the stomach, and vomiting of large quantities of

Cholera, 315

a similar fluid from the stomach. The abdomen feels doughy.
The thirst is intense, and there exists an urgent desire to drink
cold water. The mind, for the most part, remains comparatively
entire, but the vertigo and tinnitus increase. Cramps are gen-
eral attendants — sometimes confined to the fingers and toes; at
other times they affect the muscles of the extremities, and often
those of the trunk of the body, more particularly of the abdo-
men. The urine is generally suppressed early in the disease.
The voice is whispering, the person being unable to speak in any
other tone. The respiration, although weak, is often nearly nat-
ural in other respects, even at times when the pulse is scarcely
perceptible at the wrist; occasionally, however, the breathing is
hurried and oppressed, sometimes laborious. The pulse becomes
weak and rapid early in the disease, even when the action of the
heart is comparatively strong and tumultuous; but frequently
both the pulse and action of the heart are feeble. As the dis-
ease goes on both become . more and more weak ; the pulse is
only now and then felt like a "flutter,^' and often ceases to be
perceptible at the wrist for some hours before death. The tongue
is cold and shrunk.

It is quite painful to a bystander to watch the restlessness
and impatience of the sufferers, who are constantly iji a state of
jactitation, more particularly when restrained and when heat is
applied. Indeed they seem to have a horror of, and to suffer
pain from, warm applications. The temperature of the body,
but more particularly of the extremities, diminishes early in
the disease, and goes on sinking. It is often impossible to raise
the temperature of the body during life, but the moment death
takes place, and for twq or three hours afterward, the body
becomes warm — even the icy coldness of the extremities gives
place to a genial warmth. The color of the hands and feet
becomes changed, more particularly the nails assume a blue ap-
pearance ; the face often is similarly affected ; occasionally the
whole surface presents a blue color, and, consequently, the sec-
ond stage has sometimes been termed " the blue stage ;" but it is
an error to suppose that the blueness is invariable, or that it

316 Cholera,

is an attendant only on the worst forms of the complaint; the
patient who had this appearance more strongly marked than any
other was the one who made the most rapid and the most
complete recovery. Blood drawn from an artery or vein during
this stage flows with difficulty, is of a dark color, does not coag-
ulate or separate any serum. It remains in a semi-fluid state,
and has the appearance which the ancients called " dissolved
blood." The surface of the body is covered, for the most part,
with a cold exudation, the features and eyeballs shrink, and
death closes the scene — sometimes very unexpectedly, at others
the body seems to have been long dead, while the functions of
brain are still going on and are comparatively entire.'' (Mack-
intosh's Practice, vol. 1, pages 378, 379.)

Considering now only the cases which died, it will be seen
that in them the conversion of food into blood very soon ceased.
In cholera the first symptom which attracts attention is the
copious pouring out of watery discharges from the bowels.
Very soon after these discharges commence, the vital processes
for the conversion of food into blood cease to act.

The poison which produces cholera, whatever it may be, dif-
fers from miasmatic or malarial poison in this, the first causes the
serum of the blood to be poured out through the mucous mem-
brane of the stomach and bowels, producing copious vomiting
and profuse diarrhea, while the latter (miasmatic poison) ordina-
rily does neither. The diarrhea commonly precedes vomiting,
and it sometimes continues for some hours before the strength
of the heart's action is much disturbed. The ague of an inter-
mittent fever, and the cold stage of congestive fevers are some-
times attended by as much coldness of the limbs and body, felt
by the patient, as the cold or collapsed stage of cholera.
The difference is in the sensation of cold. In the collapse of
cholera the breath is cold and the temperature upon the surface,
measured by the thermometer, is no doubt lower than the tem-
perature of the surface in an ague; but in the latter, if the
patient is dressed and sitting up, he wants to get near the fire,
if in bed, he asks for more blankets. In the collapse of cholera,

Cholera. 317

on the other hand, the patient does not complain of cold, and it
is unpleasant to him to be near to a fire, and when in bed they
very commonly ask that the bed-clothes be removed; and yet
patients constantly recover, in all parts of the world, from the
ague of an intermittent. I have been familiar with inter-
mittent fevers since my childhood, and never knew or heard
of a patient dying in the cold stage of an intermittent fever.
Patients also constantly recover from the first and second
paroxysm, or cold stage of congestive chills. So well marked
are the stages of these forms of miasmatic disease, that period-
icity is considered as one of their remarkable peculiarities.
Ordinarily reaction always follows the ague or cold stage, which
is followed in its turn by the sweating stage. But in these mias-
matic maladies there is no pouring out of the serum of the blood
by excessive diarrhea. This discharge of serum alters at once
the healthy condition of the blood, and the greater the loss of
serum the more complete is the altered condition of the blood.
As remarked by Dr. Mackintosh, it becomes thicker. This loss
of serum and the thickened condition of the blood immediately
disturb the action of the heart and the entire circulatory system.
Minute by minute, as the action of the heart in cholera becomes
weakened, less blood consequently passes through that organ and
through the lungs. This necessitates the accumulation of blood
in the vena cava and the large veins emptying into it. Dr.
Mackintosh found the vena cava distended to one and three
fifths of an inch in diameter. Ordinarily its diameter is one
inch.

Up to a certain time in the progress of these pathological
conditions there is a greater accumulation of blood in the veins,
which make up the portal system, than there is in the veins
found in the cavity of the chest or of the skull. The first alvine
discharges, which constitute the diarrhea of cholera, are mixed
with the fecal matter and bile then found in the bowels. But
very soon the fecal matter and bile are no longer to be seen.
The liver has ceased to secrete bile. The only form of bile
which can be secreted under this condition of things is that

318 Cholera,

formed from effete matter. This is accumulating rapidly. But
the blood has become altered, thickened, by the pouring out of
its serum. This applies to the arterial as well as to the venous
blood. The action of the heart is already weakened, causing
less blood to be sent through the arteries. Very soon after the
peculiar symptoms of cholera begin to intensify, the breath
becomes cool, and the blood, receiving less and less oxygen as
it passes through the lungs, is not arterialized. Consequently
a smaller quantity of blood, not properly oxygenated, is sent to
the liver through the hepatic artery. The liver, like every other
gland, depends upon the arterial blood thus sent to sustain its
vitality, and to enable the secretory organs found within it to
perform their functions. We have here in the liver a double
difficulty. Thickened blood, not normal in any particular, is
brought to it by the portal vein ; and the arterial blood brought
to it through the hepatic artery is deficient in vital elements.
Unless the disease is arrested these difficulties are continually
increasing. They are sufficient at the beginning of the disturb-
ances, already alluded to, to arrest the secretion of bile in the
liver. Indeed, every secretion in the body may be said to be
arrested; for the pouring out of the serum of the blood under
the form of rice-water discharges, and the cold sweats upon the
surface of the body, can not be called secretions at all. I main-
tain that bile is secreted from effete matter, as well as from food,
and say that, in the condition of things referred to, it can only
be formed from effete matter floating in the blood. Physiolo-
gists teach that it is formed or secreted from the blood — how,
they do not explain; but they certainly teach that it is continu-
ally formed and continually poured out, in the duodenum, in the
state of health at least.

It matters not whether my explanation as to the source and
formation of bile, or their no explanation, be correct in this in-
quiry. Be that as it may, if the bile il not secreted by the liver
from the fluid brought to it by the portal vein, another disturb-
ing cause must be at once set at work. It is the province of the
liver to remove two pounds and one half of bile from the blood

Cholera, 319

every twenty-four hours. So say all the books. Somehow or
other, or from some cause or other, this bile is not removed.
Then its constituent elements must remain in the blood, and this
at a time when the vital fluid is becoming thicker every moment
by the pouring out of its fluid parts through the bowels and the
skin, and becoming darker or blacker by not receiving the
healthful quantity of oxygen as it passes through the lungs.
During this state of things the blood passes very slowly through
the liver; it becomes congested in that organ.

I say the blood passes slowly through the liver; it simply
passes through, because it is not acted upon by the secernent
organs. All of this increases the congestion of the portal veins,
of the pancreas and spleen, and of the great veins found within
the abdomen. The spleen has ceased to empty rejuvenated blood
containing an increased quantity of albumen and fibrin into the
veins which convey the blood from it. The secretion of urine
by the kidneys begins to be suspended at a very early stage in
the progress of the pathological conditions which constitute
cholera ; and it soon ceases altogether. If the kidneys act upon
effete matter, it would seem that now was the time, of all others,
that they should be actively at work. But the conversion of
food into blood has stopped entirely, and they have no longer
any thing to do in the blood-making process. They do not even
separate water from the blood. The skin and mucous membrane
of the bowels have this pathological work thrown upon them.
But the kidneys are very soon rendered incapable of performing
any secretory function. There being no valves in the veins
which convey the blood from the kidneys to the vena cava, the
renal veins are very soon filled with blood as the consequence of
the distended fullness of that great vein. This congestion of
the kidneys places them in a pathological condition. A time
soon arrives when there may be said to be a separation between
the brain and nervous system and the rest of the body. Those
\vho have used the galvanic battery with the copper trough and
zinc plate suspended in it, know that the battery and the trough
are connected by two short, bowed, copper wires. If either of

320 Cholera,

these wires is removed when the battery is actively at work, it
stops instantly. I can not better illustrate what appears to me
to be the condition of things in the body of a cholera patient,
when the operations of the mind are clear and intellectual while
the body is seemingly dead, than by the above comparison. But
there is another way of illustrating it. It is well known to all
who are accustomed to use the kind of battery spoken of, that the
solution of sulphate of copper (the fluid commonly used), must
be of a certain strength; otherwise the battery will not work,
though the connecting wires be in place, and every thing else all
right. Now in the human body the blood represents the solution
of the sulphate of copper which fills the trough in which the zinc
plate is suspended. The blood in a cholera patient has become so
altered by the various morbific processes to which it is subjected,
as stated above, that it is no longer able to stimulate, to excite,
or to put into active operation the brain and nervous system,
which may be called the galvanic battery of the animal body.
It is when this break between the batteries of animal and organic
life occurs that the valves in the veins become powerless. Up to
a certain time in the cold stage of cholera the surface of the
body has a shrunken appearance, all the smaller veins having
apparently emptied themselves. The action of the heart at this
time being very feeble, very little blood is sent into the arteries
which go to the surface of the body. So long as the valves in
the veins continue to have their natural power, the blood contin-
ues to be emptied by these veins into the larger veins within the
chest and abdomen, so as to increase the accumulation of blood
in the great veins found in these cavities. But when the valves
give way the whole system of blood-vessels, arterial as well as
venous, including the heart, seem to become as so many caout-
chouc tubes and pouches, and the blood is forced through them
all indiscriminately as through a sponge. I suppose that the
pressure of the atmosphere upon the human body would be suf-
ficient to do this. Dr. Mackintosh states that the lungs are«
found excessively congested ; in one instance they weighed as
much as three pounds and nine ounces.

Cholera, 321

I have already alluded to the fact, which must be admitted
by every one who has any knowledge on the subject, that when
the action of the heart becomes exceedingly weak, as is always
the case in the collapse of cholera, but a very small quantity
of blood is sent to the lungs through the pulmonary artery.
The congestion of the lungs, then, can not be caused by the
amount of blood brought to them through that artery, for as
long as the patient continues to breathe and the heart to beat,
the blood carried to the lungs through the pulmonary artery
will return to the left side of the heart through the pulmonary
veins. This congestion of the lungs, then, approaching almost
to pulmonary apoplexy, must be accounted for in another way.

In another chapter, where I have spoken of the azygos vein,
I stated that the bronchial veins emptied into the azygos vein,
and that these veins have valves in them. I suppose that the
excessive congestion of the lungs found by Dr. Mackintosh in
cholera subjects can only be accounted for upon the supposi-
tion that these valves had given way ; as they had also done in
the superficial veins. When these valves do give way, the
enormously distended veins within the cavities will then relieve
themselves, in part, of their excessive congestion. The bron-
chial veins then become filled with the blood which is forced
back into them from the vena cava. The blood within the cavi-
ties being still warm, when it thus returns to the external parts
of the body, produces a corresponding warmth in them. But
it is in this way that I account for the bodies of cholera sub-
jects becoming warm after death, when during life they were icy
cold.

I saw a striking instance of this in 1849. The patient was a
middle-aged woman. I saw her a short time before she died,
when her limbs and body were unusually cold even for a cholera
patient. Several hours after her death, when they were pre-
paring to bury her, I was sent for. Her body had become so
warm that the attendants thought she was coming to life again.
This state of things does not occur in all cases ; but when it does
occur, my explanation is, I think, the anly intelligible one. It

21

322 Cholera.

is only a supposition, but I conjecture it, that the valves begin to
give way before death.

I have thus briefly given my views as to the pathological con-
ditions which occur in cholera patients who die. They are based
upon the post-mortem examinations made by Dr. Mackintosh. I
have treated patients during three epidemics of cholera — 1849,
1853, and 1855. No post-mortem examinations were made here.
The symptoms and the stages of the disease corresponded exactly
with those reported by Dr. Mackintosh as occurring in Edinburgh.
The post-mortem appearances observed at different times and at
different localities, by physicians of eminence who made them,
differ in some respects a good deal from those observed by Dr.
Mackintosh at Edinburgh. This difference applies particularly
to the condition in which the lungs, the brain, and the spinal
cord were found by him.

Dr. Austin Flint says, in his Practice, "The lungs, in some
cases, contain but little blood, and in other cases more or less
hypostatic congestion is observed.^' He says, "The spinal cord
offers nothing abnormal. The ganglions and nerves of the sym-
pathetic system present nothing abnormal.'^ The same condi-
tions have been observed by many physicians both in this coun-
try and in Europe. Indeed, so far as my reading goes, the lungs
have been found comparatively empty of blood. All physicians
who have treated cholera agree, I think, in this, that during the
cold stage very little blood passes into the lungs through the
pulmonary artery; so that it would be unreasonable to expect to
find them filled with blood, as observed by Dr. Mackintosh, unless
the blood is forced into them through the bronchial veins, whose
valves have lost their natural power, as I have already ex-
plained.

In Dr. John Chapman's work on Diarrhea and Cholera, in a
note at page 246, you find the following: "Post-mortem state of
the sympathetic system and the pneumogastric nerves in cases of

death during the choleraic collapse He, Dr. George

Steele, says, * I am anxious to call attention to one feature which
was very constant in the cases I examined, and which, though it

Cholera, 323

can not be without importance, has, apparently, either not existed
or escaped the notice of writers since 1832. I aUude to a singu-
larly hyperemic state of the sympathetic system and the pneu-
mogastric nerves. It was not unusual to find congestion more
or less extensive in every portion of the sympathetic chain of
ganglia. The splanchnic nerves, the semilunar ganglia, and the
solar plexus were the parts chiefly involved, and these not unfre-
quently were imbedded in extra vasated blood.

'^ The celiac, renal, esophageal, cardiac, and pulmonic plexuses
exhibited morbid lesions of the same kind, but generally to a
less extent. The neurilemma of the pneuraogastric nerve fre-
quently injected, and studded with ecchymosed spots; and in
one case I found the phrenic nerve, where it spreads out upon
the diaphragm, steeped in a large coagulum. In one case also
Mr. Lizars found the same nerve involved, its neurilemma in
the thorax being injected all the way to the diaphragm."

The reader will observe that Dr. Steele says that the post-
mortem appearances observed by him had either not existed or
escaped the notice of writers since 1832. This was about the
time of Dr. Mackintosh's observations. Considering the care
with which post-mortem examinations have been made since
1832, it is not reasonable to suppose that any such marked char-
acteristics of the nervous system (post mortem) would have
escaped the notice of medical examiners. This is the more par-
ticularly true, because since then especial attention has been paid
to the nervous system, and no opportunity for examination has
been permitted to pass unnoticed. The only conclusion, then, at
which any reasonable man can come to is, that the post-mortem
appearances in the nervous system observed by Dr. Mackintosh
and Dr. Steele are among the unusual conditions observed in
subjects who die of cholera.

If the reader will refer again to the chapter in which I speak
particularly of the azygos vein, he will find that veins going
from the spinal column and the ganglions of the sympathetic
nerve empty, for the most part, into the azygos veins. These
veins, as already repeatedly said, have valves in them, and

324 Cholera.

empty themselves into the vena cava, when the action of the
heart becomes weakened, as is always the case in the collapse of
cholera; and in the approaching collapse very little blood is sent
to any part of the body, and all the veins which have valves
empty themselves and can not become congested. Dr. Chap-
man uses the words hyperemia and congestion as synonymous.
I have already pointed out the confusion to which this leads.
There can not be arterial fullness or hyperemia in any part to
which but little blood is sent. There can not then be arterial
hyperemia in the spinal column or the ganglions of the sympa-
thetic nerves during the cold stage of cholera, or during the ague
of a miasmatic fever. Nor can there be venous congestion in
parts where the veins have valves; unless the valves have lost
their power, and permit the blood to be forced back into them
from the great and exceedingly congestsd veins within the cavi-
ties of the chest and abdomen.

In the subjects examined by Dr. Mackintosh and Dr. Steele
I suppose the congestion of the vena cava and of the veins
emptying into it was excessive, and that the valves in the bron-
chial and azygos veins were made to give way ; and hence the
excessive congestion of the lungs observed by Dr. Mackintosh,
and of the spinal column and nerves observed both by him and
by Dr. Steele. When the valves referred to give way, death is
inevitable. In fact it is the beginning of death. Indeed, after
death from any other malady, the valves in the veins still have
the power of preventing the blood flowing back into those veins.

All post-mortem examinations of cholera subjects, and par-
ticularly those made by Dr. Mackintosh and by Dr. Geo. Steele,
show clearly that cholera is a disease in which congestion of the
great veins within the cavities is most complete. This conges-
tion, in and of itself, so interrupts the action of the heart as to
render the circulation of the blood to be very slow and incom-
plete. There is then very little motion in the current of the
circulation. All glandular secretion is entirely suspended, and
hence there is a very slow circulation of blood through the
glands. The blood may be said only to pass through them, for

Cholera. 325

uo glandular or catalytic action is exerted upon it. The trans-
formation of food into blood, which according to my theory is
going on in every part of the body during health, is entirely
suspended. Not only all the actions connected with the vascular
system, including the arterial, venous, and capillary, are inter-
rupted; but the lymphatics also, which according to my views,
perform an important part in the conversion of food into blood,
cease entirely to do the work allotted to them in the animal
economy. The lymphatics soon empty themselves of all the
lymph which they had formed, and, having valves, they after-
ward remain empty.

This is one of the explanations why the veins were found by
Dr. Mackintosh, and by some other observers, to be so enor-
mously distended; so completely filled, indeed, that they could
not hold all of the fluid, called blood, so that even the ar-
teries (post mortem) were found to contain a large quantity
of blood.

In the majority of cholera subjects, the liver was found to
be congested ; but in some it was not particularly so. The rea-
son for this is, I think, of easy explanation. A full, or a larger
quantity of blood, if I may so express it, goes to every gland or
secreting organ, when the functions of that organ or gland are to
be actively performed. The liver, according to my teaching,
performs two glandular functions: the one, in acting upon the
food in passing through it, and the other in acting upon eifete
matter. Under this condition of the circulation of the blood
the liver might or might not be congested.

As already stated, the conversion of food into blood very
soon ceases in a cholera patient; and soon after this the liver
is incapacitated to make bile out of eifete matter; so that it per-
forms no function at all. In a short time after the rice-water
discharges begin to be poured out; in a short time after the
action of the heart becomes weakened; in a short time after the
whole volume of blood, considered as a whole, receives but a
small quantity of oxygen from the air inspired ; in a short time
after animal heat ceases to be generated, because of impeded

326 Cholera:

motion in all parts of the body; in a short time after, I say, all
these four coincident circumstances, but a very small quantity of
blood is sent to the liver through the hepatic artery. Active
glandular and catalytic actions in an organ, whose special func-
tions are to secrete, attract blood to that organ; but as no such
functions are performed by the liver under the conditions stated,
and as the veins which go to form the portal vein are suscept-
ible of great distension, we can readily understand that the ac-
cumulated blood within those veins might remain almost stag-
nant within them, while but a small quantity of it simply passed
through the liver. I will not here pretend to say what the
cause of cholera is.

This malady existed in India perhaps from time immemorial.
It may have existed in China for as long a time. European
writers are agreed that it developed itself in an unusual manner
in India in the year 1817. According to the Abbe Hue it made
a development equally alarming in China in 1819 or 1820. It
first appeared in Europe and the United States in 1832. Accord-
ing to M. Hue it was heralded in China by unusual and terrible
atmospheric phenomena. In Europe and the United States it
has, with a few exceptions, prevailed during the summer months.
Its greatest mortality has been when the temperature of the
atmosphere was high. In Lexington and in Versailles, twelve
miles from here, persons of the first intelligence, and in every
other respect entirely reliable, testify to the fact that, when
approaching these towns, they smelt a peculiar odor. Individ-
uals who would leave these places and be absent for a day or
more, testify that the olfactories informed them of the fact that
they were entering a cholera atmosphere when they returned.
Many physicians testify to the fact that, when called to a house,
they could tell as soon as they entered, by the smell, whether their
patient had the cholera. I do not doubt that the cholera poison
is atmospheric; but inasmuch as only a limited number of the
population of a town or village is attacked, there must be some
other cause or influence why some have the malady while others
escape.

Cholera, 327

Dr. Mackintosh found in his post-mortem examinations appear-
ances which showed the existence of chronic maladies in those
who died of cholera. But all physicians know that many young
and apparently healthy men and women take the disease and die
with it. But this applies to so many other forms of mortal mal-
adies that it is not remarkable. While I believe the disease to be
atmospheric, I have no doubt that this atmospheric influence is
local ; and that it may begin and terminate in this circumscribed
locality. If any one will call his attention to it he will fee aston-
ished to find how circumscribed and local rains sometimes are.
This particularly happens in very dry seasons. During the sum-
mer of 1872 there were frequent and abundant rains in Lexing-
ton, when on several of the thirteen turnpikes going out of this
city there was not rain enough to lay the dust within a mile of
the tow^n. In 1833 the cholera was very bad in Lexington, and
there was not a case in Versailles, twelve miles off. In 1834 it
was terribly fatal in Versailles, while there was not a case in
Lexington. In 1849 it prevailed at the lunatic asylum near the
city limits for six weeks before there was a case in Lexington,
while there was constant intercourse between the two places.

Epidemic or Asiatic cholera is considered to be a different
disease from the malady called cholera-morbus, and from the mal-
adies called summer complaint and cholera-infantum of young
children. While I do not doubt that there is sufficient reason
for these distinctions, I also believe that they both, or all, consist
essentially in the partial or total suspension of the conversion of
food into blood. When I was a boy, studying natural philoso-
phy, there was a little contrivance used to show the attraction of
gravitation and the power of increased velocity. A rope was
placed over a beam, at the end of which were two rpllers. At each
end of the rope a little contrivance was fixed of equal weights;
so that they balanced each other. Then a weight which projected
beyond this contrivance was placed on one of them. This caused
it to descend rapidly; but after falling a few feet it passed through
a ring which took off the weight, but yet it continued to descend
to the ground. Now I suppose that after the cause of cholera

328 Cholera,

has so far affected the animal body as to cause the pouring out of
the rice-water discharges; so far as to produce a weakened action
of the heart with all of the other pathological conditions before
referred to, as to the lungs, liver, and glandular system, gener-
ally; I say, that if after all these pathological conditions have
set in the cause could then be removed, the patient would still
succumb unless something was done to arrest these pathological
disturbances. There are some persons, and among them may be
found physicians, who deny that a patient ever recovered from
the malady generally known as Asiatic cholera. I will refer to
them hereafter. The medical world, however, both in Europe
and in this country, have been agreeably surprised, I may say, at
the remarkably quick and complete recovery of many persons
who were supposed to be almost in articulo mortis. This has
been observed in cases too numerous to mention. It goes to
show, I think, two things conclusively: First, that the materies
morhiy or the cause of the disease, is not a poison like unto that of
smallpox, of typhoid fever, of measles, and scarlet fever; and
second, that up to a certain time in the process of the patholog-
ical changes constituting cholera, no organic lesion has taken place
which is in itself mortal. During the past year cholera prevailed
in Kentucky, in certain towns, with considerable fatality. Ac-
cording to the reports published fully one half of the cases died.
I believe it is now generally agreed both here and elsewhere,
in Europe and the United States, that one half of the cholera
patients die. It is a very large mortality. It is only necessary
to refer to the books written on cholera, and to the medical jour-
nals and medical reports, to satisfy one's self as to two facts:
First, that there is no agreement as to the essential nature of the
disease ; and second, that there is less agreement as to the treat-
ment of the malady. The first of these questions I have con-
sidered to some extent. The second I will now consider fully,
which involves, incidentally, a further consideration of what con-
stitutes the malady called cholera. Among the recent theories
on cholera which have claimed the attention of the medical pub-
lic, I will notice that of Dr. John Chapman, of London.

Cholera, 329

In his work on Diarrhea and Cholera, p. 99, he expresses his
theory in the following propositions: ^'1. All the phenomena of
cholera are due to simultaneous hyperemia of the spinal cord and
the sympathetic nervous system. 2. All the phenomena of chol-
era are naturally divisible into two classes, accordingly as they
are referable to the spinal cord, or to the sympathetic ganglia
as their cause. 3. All active or positive phenomena are due to
hyperemia of the spinal cord. 4. All passive or negative phe-
nomena are due to hyperemia of the sympathetic ganglia.''

I think it must be evident to all who have carefully read my
book so far, and who have not allowed prejudice or the weight
of high-sounding authorities to prevent them from considering
what I have written, that this theory of Dr. Chapman is entirely
baseless. There has been much difference of opinion as to a cor-
rect diagnosis between common diarrhea and epidemic or Asiatic
cholera; but no medical man can deny that when the malady has
reached a point at which the diagnosis may be said to be clear
and unmistakable, there is no symptom more marked and inva-
riable than a weakened action of the heart, and an interrupted cir-
culation. If by hyperemia of the spinal cord and the ganglions
of the sympathetic system Dr. Chapman means arterial fullness,
I say that it does not exist, and can not exist. When local
inflammation is set up in a part there may be a question as to
whether it consists in a fullness of the arteries, of the capillaries,
or of the veins in the part inflamed. I say medical men may,
and I know that they have, differed as to these points. But
when there is no inflammation or well-marked irritation even in
a part, as there certainly is not in either the spinal cord or the
ganglions of the sympathetic system of a patient who unques-
tionably has cholera, there can not be hyperemia of the arteries
going to these parts when the action of the heart is weakened,
and is growing weaker every hour. The spinal cord and the
ganglions of the sympathetic system not being supplied with the
usual and healthful quantity of blood commonly sent to them,
can not stimulate the nerves going from them, or either of them,
to excessive or unusual action. If by hyperemia of the organs

330 Cholera,

referred to he means venous congestion, such as was observed
post-mortem by Dr. Mackintosh and others, I say, first, that
venous congestion never excites or stimulates any organ to
healthful secretion ; and secondly, that such venous congestion in
the spinal cord, in the ganglions of the sympathetic system, and
in or about the nerves going oflF from either of them, only shows
a pathological condition which incapacitates one or all of them
for healthy action of any sort. The first principles of Dr. Chap-
man^s theory being without foundation in either physiological or
pathological anatomy, the superstructure intended to be raised
upon it must fall to the ground.

I might here stop in the consideration of his theory, but I
will notice briefly several points which he makes; he speaks
of excessive activity of the mucous membranes, and of all the
glands of the alimentary canal. I deny that either of these
conditions obtains in cholera. Perspiration is a natural, healthy
function of the skin ; but the colliquative sweats of consumption,
and the cold, clammy sweats of cholera, can not be said to depend
upon the excessive or even active perspiratory functions of the
skin ; but are rather evidences of the powerless condition of the
perspiratory glands to prevent the pouring out of the watery
parts of the blood. Healthy perspiration is warm. The sweats
of consumptive patients and of cholera patients are cold. The
healthful action of the mucous membrane of the alimentary canal
is to secrete a sufiicient quantity of mucus to lubricate it; but
when the quantity of mucus poured out is excessive, it is to be
attributed to a deficient action, and is like unto the cold sweats
above referred to. Dr. Chapman not only speaks of an excessive
action of all the glands of the alimentary canal, but he also
refers to the fact that these glands are sometimes found enlarged
after death in cholera subjects.

I have in a former chapter referred to the fact, which I think
no physiologists will deny, that all healthful glandular action
ceases whenever the force and power of the heart's action are
greatly increased, as in fever; or whenever, from whatever
cause, this force and power are greatly weakened; as all phy-

Cholera, 331

sicians know that they are in cholera. There is, I affirm, no
glandular action of any sort going on in the body of a cholera
patient after the attack may be said to be established. The
quantity of mucus found in the rice-water discharges is small
compared with the quantity of serum, or the watery parts of the
blood. They are both poured out because of the excessive con-
gestion of the abdominal viscera, particularly of the stomach
and bowels, and because of the want of power in the organs
which make up the alimentary canal, glands, and membrane, to
resist or prevent the pouring out of these excessive quantities of
this so-called rice-water from the blood-vessels. The quantity
of desquamated epithelium found in the rice-water discharges
is the result of the destructive changes taking place in the mu-
cous membrane of the bowels. The enlarged condition of the
glands, found in the bowels after death in many cholera subjects,
can have, I think, but one explanation. The enlargement is
due to the excessive congestion of the abdominal viscera, and
of the bowels in particular. The action of the liver having
ceased for some time before death, the veins which go to make
up the portal vein, and particularly those which go from the
mucous membrane of the bowels, can not empty themselves
neither before or after death. Hence these small glandular
bodies remain in an enlarged or swollen condition.

At page 106 Dr. Chapman says, ^'Abnormally high tempera-
ture within the rectum. — The doctrine that the white substance
expelled from the bowels, or found in them after death, is not
the result of passing exudation, but is chiefly a product of ex-
cessive glandular activity, is in perfect accordance with, and for
the first time explains, the fact that during collapse the tempera-
ture within the rectum is extraordinarily high, and that it falls
simultaneously with the emergence of the patient from that
state. In a case of cholera, mentioned in the Lancet in 1832,
the temperature in the rectum was 105°."

" Late experiments in Paris,'' as remarked by Dr. Mackpher-
son, "show that the temperature rises to about 103° in the
rectum.''

332 Cholera.

In a case of collapse, "not in a severe form," under the
care of Dr. Weber, the temperature in the axilla on the second
day of collapse was 97° F., while that in the rectum was 100.5°;
on the following day it was in the axilla 97.6°, in the rectum
99.5°; and, again, a day later, in the axilla 98°, in the rectum
99.1°. Dr. Weber remarked that he had also found, in several
other instances in which he had examined for it, that during the
collapse the temperature in the rectum was more or less above
the average of health; that it had been in one case of severe
collapse as high as 103°, while in the axilla at the same time
it scarcely exceeded 95° ; that with progressing recovery the tem-
perature in the rectum had decreased, while that in the axilla
had increased. "In interesting accordance with these facts the
temperature in the groin is found to be higher than it is in
the axilla."

In some remarks introductory to the lengthy extracts taken
from Dr. John Esten Cooke's book, I said that I believed that
he was the first medical man who fully and correctly understood
what was meant by, and what really is, venous congestion. No
symptom has been more noticeable in cholera than this, viz.
that cholera patients complain always of great internal heat
within the abdomen; and crave cold water to relieve, as they
suppose, this internal heat; that is to say, they seem to think
or feel that a large quantity of cold water will relieve them
of their torment.

By reference to the extracts from Dr. Cooke's book, it will be
seen that when there is excessive congestion of the vena cava,
this congestion extends to the hemorrhoidal veins and to all the
veins within the pelvic cavity, including the iliac veins, in the
collapse of cholera the congestion of these veins is excessive.
The heat in the abdomen complained of by cholera patients, and
the heat found by the themometer within the rectum, is to be
accounted for by the excessive quantity of blood which has ac-
cumulated within those veins; which blood is undergoing patho-
logical changes. Besides this there is excessive pathological
action or motion in the mucous membrane of the stomach and

Cholera. 333

bowels coincident with the excessive pouring out of the rice-
water discharges.

I have said, in another chapter, that heat and motion were
coexisting facts. The heat referred to by Dr. Chapman is, then,
to be accounted for by the enormously increased quantity of
blood found within the abdominal and pelvic cavities, which
blood seems to have left almost all other parts of the body, and
by the pathological activity involved in the pouring out of the
serum of the blood. But there is no glandular action in the
case at all. We know that there is greatly increased heat in
many fevers correlative with increased motion in the circulation
of the blood, but no glandular secretion of any kind goes on
while this fever exists. There being, then, an enormous quantity
of blood in the abdominal and pelvic cavities, it would of itself
account for the increased heat felt in those parts ; but when we
add to this the excessive action involved in the pouring out or
effusion of the rice-water discharges, when they occur, there is
no difficulty in accounting for the increased heat complained of
by patients and that found in the rectum by the thermometer.

On the cold breath in cholera Dr. Chapman says, " The amount
of oxidation throughout the body, the lungs themselves included,
being very slight, the temperature of the small amount of blood
passing through the lungs is extremely low; and, of course, the
very small quantity of carbonic acid and watery vapor which is
exhaled being comparatively cool, is able to raise the temperature
of the residual air in the lungs, and of that which is expired
very slightly indeed.''

Dr. Chapman explains this condition by his theory; but what
he attributes to contraction of the arteries I explain by weakened
action of the heart and excessive congestion of the great veins.
The arteries always contract or dilate to accommodate themselves
to the quantity of blood passing through them. In the cold
stage of cholera, when the action of the heart is excessively
weak, but a small quantity of blood passes through the lungs
and enters the arterial system. Of course under this state of
case the arteries contract so as to accommodate themselves to

334 Cholera.

the lessened quantity of blood in them. The limited extent to
which oxidation takes place in the lungs because of the small
quantity of air inspired, and the limited extent to which it takes
place in all other parts of the body because of the total extinc-
tion of all glandular action, which action involves motion, has
very much to do with the cold stage of the patient. That the
nervous system is involved there can be no doubt ; but there is
no lesion of the nerves, except when all chances for recovery
have passed away; much less is there any condition which could
be properly called hyperemia of the nervous centers.

I will call attention to what Dr. Chapman says in regard to
the condition of the spleen in cases of cholera. " In intermit-
tent fever the spleen, as is well known, becomes enlarged, and
extremely so if the disease attacks the patient many times. In
fact, as a consequence of this disease, rupture of the spleen
sometimes occurs. The first distension of the organ is, I be-
lieve, coincident with the first onset of the cold stage; and the
oftener this stage recurs, the larger the spleen becomes. Now
the remarkable way in which the spleen is thus aifected during
the course of ague, is, in my opinion, an instructive illustration
of what occurs in the same organ during the collapse of cholera,
as a result of the energetic action of the negative motor nerves.
By constringing the systemic arteries throughout the body, and
thus emptying, or nearly emptying, all but the larger trunks,
they force the blood in every possible direction in which it
encounters the least resistance; the spleen is thus made the
receptacle of an enormously large quantity, which distends it
extremely, and produces the great pain, as well as the sense of
burning heat, complained of in the left side. It seems to me
probable that the considerable heat of this mass close to the
stomach, which is itself the seat of intense glandular activity,
and therefore hotter than natural, affords the explanation why
cold drinks and ice are so peculiarly grateful to patients in col-
lapse. The post-mortem condition of the spleen of patients
dying in collapse, differs, as already stated, in different patients.
By referring to paragraph fourteen of the previous chapter, the

Cholera. 335

reader will, however, find evidence that the spleen is often
observed after death to be enlarged, and to present internally
vestiges of extreme congestion. Though it is also often found
small, this fact does not disprove the hypothesis that it was con-
gested and distended before death; for considerations hereafter
adduced justify the belief that in those cases in which the spleen
is found of normal size, there has been a reflux of blood from it
at the time of and after death produced, as will be described in
the paragraph in which I shall account for the elevation of tem-
perature after death.

Referring to a report of seventy cases examined by Yirchow,
Dr. Gull says, "During life he (Virchow) had repeatedly, by
percussion, been able to determine that it (the spleen) was decid-
edly enlarged ; and in some cases, patients had complained of
pain in the left side. In old persons no enlargement was ever
observed ; but in almost all other cases the spleen was so flaccid
and shriveled, that one was obliged to admit a previous enlarge-
ment, or rather so recent and rapid a reduction of volume that
the capsules had not yet accommodated themselves. The change
of color in the tissue, from altered blood, led him to infer a pre-
vious hyperemia."

Dr. Chapman is certainly correct in supposing an exact simi-
larity in the condition of a patient in the cold stage of an inter-
mittent and in the collapse of cholera, so far as the congestion
of the spleen and the veins which go to make up the portal
circle are concerned. He says that both are to be accounted for
by the energetic action of the negative motor nerves. Were we
not familiar with the bewilderments in which a man sometimes
finds himself when attempting to explain an absurd theory, it
would be difficult to tell how a medical writer of Dr. Chapman's
erudition could suppose that there was an energetic action of
any part of the nervous system during the cold stage of an
intermittent, or during the collapse of cholera. But he is en-
tirely correct as to the fact that the spleen is excessively con-
gested in both of the conditions referred to ; the only difference
being that the spleen becomes enlarged from congestion after

336 Cholera.

many repeated agues, while in cholera excessive congestion is
coincident with the collapse, which may be called in this connec-
tion as one or a single paroxysm of the cold stage.

As before remarked, in pointing out the differences between
cholera and intermittent fevers, I said that in the latter there
was no diarrhea, while an excessive diarrhea, or the pouring out of
the rice-water discharges, was almost a pathognomonic symptom
of cholera. This excessive pathological action, not glandular
action, but simply action, causes the blood to flow more freely to
the abdominal viscera so long as the heart has any power to
compel the blood to flow in any direction.

In the condition of things under consideration I would call
the attention of the reader to the difference then existing be-
tween the liver and spleen ; which is this, that but a small quan-
tity of blood is carried to the liver through the hepatic artery,
while the over-distended portal vein is pressing upon the liver
to allow the blood to pass through it.. If the blood could so
pass, as in health, the congestion would soon be removed; but
inasmuch as all glandular action is suspended in the liver, no
bile being formed, the liver can only receive a limited quantity
of blood, sufficient, however, to congest its blood-vessels to a
considerable degree. But inasmuch as a much larger quantity
of arterial blood is carried under any and all circumstances to
the spleen than to the liver, the spleen would soon become con-
gested from the supply of arterial blood alone, because the veins
going from it are not able to carry off the blood because the
portal vein can not freely empty itself through the liver. There
is another reason for the excessive congestion of the spleen in
the condition of things under consideration, to wit, there being
no valves in the veins coming from the spleen, and those veins
being large and comparatively short, the large amount of blood
coming from all other parts of the abdominal viscera is dammed
back into the splenic veins.

I agree with Dr. Chapman as to another fact, which is this:
It is sometimes found after death that the spleen is not much
enlarged or congested, while there is the strongest evidence to

Cholera, 337

prove sucli congestion, or enlargement even, as existing before
death. This applies also to the liver. I will not give his ex-
planation of this, because I do not think that it is at all more
intelligible than his theory to account for the congestion during
life. My explanation is that the congestion of both the spleen
and liver, when they disappear in articulo mortis or post mortem,
is to be accounted for by the giving way of the valves in the
azygos veins and in all other veins having valves, thus allowing
the blood to be forced back into the lungs, into the spinal col-
umn, and into the veins distributed over the surface of the body.
That the veins on the surface, which a short time before were
almost empty, as evidenced by the pallor and by the cold and
shriveled condition of the skin, do fill up, causing the body to
become warm after death, is a fact which has been observed by
all physicians, who have had much to do with cholera. Now in
this condition, when the action of the heart is so extremely
weak that no pulse can be felt at the wrist, it is preposterous to
suppose that the increased quantity of blood which is found upon
the surface has passed through the heart before it reaches the
skin; or that it is sent to the external parts of the body by the
action of the heart, causing it to go first through the lungs and
then through the systemic and other arteries. If my explana-
tion as to the giving way of the valves does not account for the
conditions referred to, then, in my humble opinion, there is no
explanation to be given.

On the death of the nervous system Dr. Chapman says, "I
have already mentioned the fact, on the authority of Professor
Parkes, that ' two or three hours before death there is often some
return of heat in the scalp and forehead, over the region of the
heart or whole chest, and it may be also over the abdomen; the
extremities are still icy cold, and the cholera visage is unaltered.
This partial return of heat on the head and trunk is an immedi-
ate forerunner of death, and, as far as I have seen, is invariably
a fatal sign ; it is occasionally confined altogether to the cardiac
region, and is sometimes astonishingly great.'

" This remarkable phenomenon is immediately due to the re-

22

338 Cholera.

laxation of the various branches of the pulmonary artery, of the
bronchial tubes, and of those systemic arteries distributed over
those parts of the body which, during the disease, have continued
most vital, and have therefore preserved the highest temperature.
The blood has continued to pass through these arteries most copi-
ously, and is thus prepared to effect their dilatation, and to flow
through them in fuller currents than before, the moment the
energetic stimulus from the negative motor nerves, which has
kept them in a state of tonic spasm, declines or ceases. Now
already, when the phenomenon in question presents itself, the
ganglionic nervous centers presiding over the arteries just men-
tioned have begun to die. Their convulsive grasp of the blood-
vessels and air-tubes, which have already proved fatal to the
system generally, is being relaxed, and they themselves are
sharing the fate which, through their agency, has overtaken the
entire organism. A last but vain effort for life is made, how-
ever, by the structures, released at length from the deadly influ-
ence of their excessive energy. The normal attraction between
the venous blood in the pulmonary arteries and the air in the
air-cells generates movement of the blood through the pulmon-
ary capillaries; it reaches the left heart, and is thence forced
most copiously into those systemic arteries just indicated, and
thence, finding its way to the starving tissues, the usual vital
changes occur. Meanwhile, as a result of the reserved oxidation
occurring in the lungs, and in the parts supplied by the newly-
relaxed systemic arteries, heat is evolved, and constitutes the
phenomenon in question. But this local struggle for life is too
late ; its possibility depends on the presence of death in the nerv-
ous system, which, soon seizing on the brain itself, closes the
scene. This local increase of temperature before death is a
strong proof that the blood-vessels are healthy ; that the struct-
ures are healthy, and suffer only from lack of nourishment; that
the blood itself is free from poison ; and that the disease is seated
in the nervous system.

."The increase or long persistence of heat in the body after
death, which is a well-established fact, is merely the continu-

Cholera, 339

ance and extension over the whole body, after the death of the
brain, of the series of actions commenced before death, and
explained in the preceding paragraph. The whole sympathetic
system having ceased its functions, the arteries throughout the
body relax ; the small supply of blood in them is drawn through
the systemic capillaries; every particle of oxygen which it can
yield up combines with the surrounding structures; and while
there are elements to continue these changes, the temperature of
the body is raised, maintained, or prevented from declining with
the rapidity usual after death from almost all other diseases.
The reflux of blood throughout the body denoted by the general
increase or unusual persistence of its heat, must inevitably result
in lessening the bulk of any organ which may have been unduly
distended with blood. Such an organ in choleraic collapse is
the spleen, which is found unusually large during life, but which,
after death, presents in respect to size no constant appearance.'*

Let the candid reader consider my explanation, and then con-
sider Dr. Chapman's. How is it possible for the blood to flow
from the right to the left side of the heart through the usual
channels after the heart has almost ceased to beat, and after it
has in fact ceased to move ; for the flow of blood of which he
speaks continues in the same manner, according to him, after
death? He speaks of the blood being drawn through the sys-
temic capillaries. I would ask, what draws it? In the case
supposed, according to him, the nervous system is dead; and we
know, as a matter of positive fact, that the heart has almost
ceased to beat, or has ceased entirely.

It has been a question among physiologists whether any other
power or force than that of the heart's action keeps up the cur-
rent of the circulation through the arterial and venous systems
from the mouth of the aorta to the right auricle; but I do not
suppose that any physiologist ever conceived fhat the circulation
of the blood through the capillary system could be carried on
independent of the heart's action. Now after this, Dr. Chap-
man's theory, to wit, that this renewed circulation of the blood
is a consequence of the death of the nervous system, in ac-

340 Cholera.

counting for the spleen's not being congested, he speaks of a
reflux of the blood caused by or dependent upon a relaxation
of the arteries. As every anatomist knows, there are no arteries
between the mouths of the veins emerging from the spleen and
the right side of the heart. All the blood flowing from the
spleen and from all other parts of the abdominal viscera, except
the kidneys, has to pass through the portal vein and the liver and
hepatic veins before it reaches the vena cava, which conveys it to
the right side of the heart. The hepatic artery, the only artery
with which this large current of the circulation comes in con-
tact, has nothing whatever to do with it. It has been repeatedly
proved tha;t injections will pass directly from the mouth of the
portal vein as it enters the liver through its minute branches into
the minute veins which go to make up the hepatic veins ; so that
a direct circulation is maintained between the portal vein on the
one side and the hepatic veins on the other.

Now if, as I suppose, the valves of the azygos veins, of the
bronchial veins, and of all other veins having valves which
empty themselves into the larger veins within the cavities ; now,
I say, if these valves all give way, allowing the distended, ascend-
ing and descending vena cava, and other large valveless veins
to unload themselves of their enormous congestion, this would
allow a free, or freer current of blood to pass from the portal
vein through the liver and hepatic vein into the vena cava,
which was becoming less distended. No other explanation need
be given of this than the laws of hydrostatics. The unloading
of the distended portal vein would remove the congestion of the
spleen in particular, and of the abdominal veins generally. The
congestion of the liver itself would be removed to some extent
in the same manner.

Dr. Chapman imagines a restored current of the circulation
with a healthful or natural production of animal heat, because,
according to him, the increased heat is produced by oxidation of
the blood, and attributes both to the death of the nervous sys-
tem. Now nothing has been more uniformly observed than the
continuance of the intellectual powers, even up to death itself, in

Cholera. 341

cholera patients. The brain, I think, according to all physi-
ologists, stands at the head of and controls the whole nervous
system.

I have already given my views as to the apparent separation
between the systems of organic and vegetative life, and of animal
and intellectual life in cholera cases where the body seems to be
almost dead, while the intellect remains clear. During the col-
lapse of cholera, or, we may say, at the beginning of the cold
stage, when the action of the heart becomes very weak, but a
small quantity of blood is sent to the brain through the arteries.
The veins within that cavity become congested, because there
are no valves in the veins going from the brain -to the descend-
ing vena cava. These veins often relieve themselves of excessive
congestion by pouring out serum into the sinuses of the brain;
but there is nothing in this condition of things which affects the
integrity of the brain itself Hence the continued clearness of
the intellect in cholera patients, although it may be feeble.

Cholera Sieca. — The Greek word cholera means a water-spout,
or the pouring out of a gutter. There can, I think, be no doubt
that the Greek physicians found this word the most expressive
of the conditions which amount to what modern writers have
called cholera. But inasmuch as patients die from this malady
who have no gushing rice-water discharges, we are forced to con-
clude that there is something operative which does not affect the
mucous membrane of the bowels. I have said a little back that
the rice-water discharges were almost pathognomonic of the dis-
ease called cholera ; but cases do occur in which there is no diar-
rhea or rice-water discharges. Without particularizing dates,
men died within five or ten minutes in Muscat, on the Persian
Gulf, and in Teheran, Persia, who had no discharges from the
bowels at all. This is well authenticated by medical writers of
unquestionable standing. To-day, 1.874, there is a very large
amount of medical opinion, for it is nothing else than opinion,
going to show that cholera is produced from one victim to another
through the rice-water discharges, or cholera discharges, which
are supposed to seep through the earth and get into wells or

342 Cholera,

springs. It is supposed that individuals who have swallowed
water or food containing these animal or vegetable parasites
have passed from one place to another, and that their alvine
discharges have entered other springs or wells from which the
persons drank who became the subjects of cholera. This is the
bad-water theory. But when we know, as we certainly do know,
that the most sudden and fatal cases of cholera occur without
any rice-water discharges, we are forced to conclude that the
cau^e of cholera does not act primarily upon the mucous mem-
brane of the alimentary canal.

The Abbe Hue says, men found themselves suddenly attacked
by a frightful disease, which in a moment deranged the entire
organization, and changed a living man into a hideous corpse.
We learn from medical writers that such was the fact at Muscat
and Teheran. I have treated cholera patients during three epi-
demics, but I only saw one case of cholera sicca; the patient, a
negro woman, lived three or four hours after the onset of the
disease. There is medical testimony enough to show that the
diarrhea, or rice-water discharges, are a coi/sequence, or the sec-
ond or third link in the chain of the morbific causes which pro-
duce the disease called cholera. I do not doubt that after the
cholera poison, whatever it may be, has aifected the system, that
bad water or particular articles of food may be efficient to develop
the malady. But it is not certain at all that these individuals
would not have had cholera if they had not drunk the water or
ate the food to which their attacks were attributed. Dr. Chap-
man supposes that solar heat acting upon the spinal cord, pro-
ducing, as he thinks, hyperemia of the cord and of the ganglions
of the sympathetic nervous system, is the efficient cause of the
malady called cholera. I have shown, I think, conclusively that
Dr. Chapman is entirely mistaken as to the physiological and
pathological functions of the human body ; but it is sufficient to
say to his theory, that large armies have from time immemorial
been exposed to excessive heat and all the other health-disturb-
ing causes incident to long marches without having a single case
of cholera among them.

Cholera, 343

In the late war in the United States of America, when there
were from time to time over three millions of men in the field,
subjected to all sorts of hardships and deprivations, there was
not a single case of cholera; although the northern army, nearly
^\e to one, was during the war in the Southern States, where the
temperature was much hotter than that they were accustomed
to at home ; and this, too, when hundreds of thousands of them
were breathing every day a miasmatic atmosphere. We are,
then, forced to conclude that neither botanical spores nor animal
products nor excessive heat, acting upon any part or the whole
human body, is sufficient in itself to produce the terrible malady
called cholera. But when we arrive at these facts, which we can
not help coming to, we are not allowed to say that either of the
causes referred to is inoperative, or has nothing to do with the
production of the malady.

As to the acidity of the blood in cholera patients, there being
some discrepancy among authors, I wrote to my very learned
friend Dr. Daniel Vaughan, of Cincinnati, and I can not do bet-
ter than give his entire letter.

" Cincinnati, February 17, 1874.

^'Dear Sir: I regret that I have found some more delay than I ex-
pected in my efforts to obtain from recent medical writings the most
reliable information in regard to cholera, the various theories respect-
ing its nature, and the facts adduced to support them.

" The late English, French, and German works which I have exam-
ined do not seem to have added much to the knowledge which existed
on the subject in the medical world fifteen or twenty years ago. The
theories hitherto advanced respecting the disease seem to be liable to
many objections, and the most eminent medical writers appear to be
wholly undecided in regard to its origin and mode of action.

" I can not find any positive statement that the blood in the victims
of cholera is always acid, but I think it is so in the majority of cases.
In the latest edition of his Practice of Medicine, Watson says that
the blood is frequently acid. Reynolds, in his Practice of Medicine,
mentions also the acidity of the blood on the authority of Dr. Grarrod,
who ascribes it (the acidity) to the presence of some organic acids.
In Schmidt's Jachrbuch it is stated, as the result of an examination
in certain cases, that the bodies of cholera patients decompose more

344 Cholera.

rapidly after death, and that their bones become soft. This softening
of the bones could be occasioned only by the presence of an acid.

'*In the French Medical Encyclopedia it is said that the vomited
matter is invariably acid, but the other excrementitious matter is fre-
quently alkaline. After death the blood is always found somewhat
dark and thickened, and this condition may be justly ascribed to a
want of proper aeration. In experimenting on animals, Dr. Brown-
Sequard found that when the venous blood is injected into arteries,
symptoms exactly corresponding to those of cholera are produced.

"A number of the authors which I have examined agree in stat-
ing that the blood contains urea, and some assign to it a small propor-
tion of uric and oxalic acids. Some of their statements appear, how-
ever, to be founded, not on direct experiments, but on the fact that
the action of the kidneys is suspended, and it would be thus reasonable
to conclude that the ingredients of the urine should be found in the
blood in a greater proportion than usual. In the few cases in which
there is any urine passed it is found to contain albumen. The blood
also, while it has a less disposition to coagulate than it does at other
times, and sometimes coagulation is entirely suspended, yet when
drawn from the body the blood is somewhat more thick than usual.
This thickness of the blood is evidently occasioned by the loss of
serum which passes away during the purging and vomiting.

**The doctrine which ascribes the disease mainly to the want of a
proper aeration of the blood derives much support from the fact that
during the prevalence of cholera the atmosphere is more free from
ozone than at other times. Ozone has a far greater oxidizing power
than ordinary oxygen, and the efficiency of ordinary air for respira-
tion depends much on the small amount of ozone which it contains;
yet atmospheric influences alone would not seem adequate to the
propagation of the disease, and there are probably some other causes
on which its diffusion depends. It has been found that in its inroads
through habitable lands it travels not with the rapidity of the wind,
but with the more moderate velocity of men in traveling and trad-
ing expeditions in different parts of the world.

** In the French Encyclopedia of Practical Medicine there is a
vast amount of evidence introduced to prove that cholera spreads by
a contagion or infection, that it passes to one individual from another
previously affected, and that it is conveyed by travelers along land
and by ships along waters. The author of the article (Dr. Marcy)
contends that it can not be transmitted to any great distance through
the air. Watson, however, mentions a case in which the cholera
poison passed from an infected ship to the steamer which towed her

Cholera. 345

into port, -and looks upon this as an instance of aerial transmission of
the seeds of the disease. Yet even in this case it is possible that the
unfortunate effect may have arisen from the fact that the tow-rope
may have been handled by the crew of both vessels in succession, as
ropes are always coiled up by sailors in throwing them from one ves-
sel to another. Many writers deny the contagious character of chol-
era on the ground that inoculation with the fluids of diseased patients
have failed to produce the disease. But these inoculations or injec-
tions have never been performed on the human subject, and the ex-
periments on animals are perhaps justly held to be inconclusive.

** Pasteur, an eminent French writer, ascribes cholera and other
diseases to animal and vegetable parasites. This parasitic theory of
late years has found many adherents and has given rise to the employ-
ment of antiseptics or prophylactics against disease. Grace Calvert,
an English chemist, adopts the doctrine of Pasteur, and regards
carbolic acid as the great prophylactic which is to arrest forever the
inroads of cholera in the civilized world. In a lecture of Calvert,
which I read some time ago, he mentions cases where hospital nurses
had their garments fumigated with the vapors of carbolic acid, and
with very few exceptions were free from all attacks of cholera. But
Grace Calvert himself has been an extensive manufacturer of car-
bolic acid, and self-interest would tend to give him an exaggerated
opinion of its utility in alleviating the sufferings of mankind.

" Of late years there has been too great a disposition to refer every
disease to parasitical animalculse, or bacteria, as they are generally
called. I lately read a very elaborate article on puerperal fever, in a
German periodical, in which the disease is ascribed to bacteria. In-
dividuals, rich enough to possess fine microscopes, seem naturally
desirous to claim too much for their labors of observation; but
though the miscroscope has done much for medicine, it would be
injury if it tended to keep investigators from other means of
inquiry.

"I may here mention another feet that seems to favor the theory
of imperfect aeration of the blood in the lungs. I allude to the great
depression of temperature, especially toward the extremities. This
in some cases is found as great as 17° to 19° of the centigrade ther-
mometer, from 31° to 34° F. If we adopt the theory that heat is pro-
duced by the oxidation of the blood, the fact mentioned must show
that the aeration is carried on in a very imperfect manner.

"According to the more recent views prevailing among the Ger-
man physicians, cholera is transmitted through the medium of intes-
tinal evacuations. It is accordingly contracted in water-closets, and

346 Cholera.

it is carried along by rivers and water-courses. It is also mentioned
as an established fact that bare deserts are an insurmountable obstacle
to the passage of cholera over them. It may be that the dryness of
the air exerts some salutary action in destroying the mysterious poison.
Egypt received the cholera first from the European vessels, though
there had been previously much communication over the deserts with
countries where the disease prevailed.

"About twenty years ago Dr. Knapp, a physician in Covington,
Kentucky, and originally from Maryland, published in a large volume
a new theory, or, as he called it, ' Discovery of the Cause and Cure of
Cholera.' According to his views cholera was only a modified form
scorbutis, and arose from defective nutrition. The evil he supposed
the same in both diseases, but by some cause it was diverted from the
skin, where it appears in scurvy, to the alimentary canal, where it
appears in cholera. Though some of his ideas were good, his reason-
ing did not appear very logical. The prophylactics w^hich he recom-
mended consisted mainly of fresh vegetable diet and are diametrically
opposite to those now generally recommended by physicians. The
opinion of the French physicians seems favorable to the use of rich
diet and animal food as a preventive of the disease. It is stated in
corroboration of the excellence of the prophylatic that the poorer
classes in the Old World suffer more than the rich, and it is said
that of ten thousand persons connected with the Imperial Court of
Russia not one was attacked with cholera at a time when it was felt
with terrible severity by the serfs and poorer population of the Rus-
sian Empire.

' ' Few subjects have called forth more discussion than the career
which this epidemic has pursued in overrunning the earth. It is
generally supposed that its course is naturally westward; but this
seems a mistake, as it propagates itself from India in every direction,
and to the Chinese it comes from the west. It has also been a ques-
tion whether cholera ever afflicted Europe before the present century.
Nearly thirty years ago Mr. Roache told me that while he was con-
nected with Transylvania University one of the medical professors,
^Vhose name I do not remember, maintained that the great plague of
Athens in 409 B. C. was actually cholera. But the authorities which
I have since read call it the eruptive typhoid fever. The works I
have lately consulted contend that the cholera has always existed in
India, but never passed the boundaries of Hindostan until 1817, when
it went as far as Persia, and 1831-2, when it took a more extensive
march around the world. There has been endless discussion as to
the cause which operates at these periods to scourge mankind, some

Cholera. 347

ascribing it to English misrule in India, others to the assemblage of
pilgrims, or to other causes.

"Your sincere friend,
"Dr. J. C. Darby." " Daniel Vaughan.

"Cincinnati, Feb. 19, 1874.
^^ Dear Sir: Though I wrote to you about two days ago, I deem
the present note necessary to answer some inquiries in your letter of
the 16th inst., which I received to-day. The latest work I could find
on the practice of medicine is that of Dr. Aikin, published in London
in 1872, and containing nearly 2,500 pages in both volumes. Aikin
cites one authority (Wood) who maintains the blood is acid in cases
of sunstroke, while he mentions another who regards the blood as
weakly alkaline. I can only reconcile these conflicting statements,
as well as others of the same character in regard to cholera, by sup-
posing that much depends on the time when the analyses were made,
and the way in which they were conducted. Fresh urine is almost
invariably acid, but after a time becomes either neutral or alkaline
in consequence of the formation of ammonia by putrefaction. Now,
in cases of sunstroke, and also in cases of cholera, the blood has a
great tendency to undergo putrefaction, and would thus lose any acid
reaction it might have possessed after being removed from the system.
"I remain your sincere friend,

" Daniel Vaughan.
"Dr. J. C. Darby."

After the receipt of Dr. Vaughan's letters I had a conversation
with a gentleman who was in St. Petersburg for five or six months
during the last epidemic of cholera in that city. He said that the
persons with whom he met at th^ hotels did not seem to be in the
least concerned about the cholera although from seventy -five to
one hundred persons were dying daily. He said that the upper and
well-to-do classes there drink no water at all except that which is
sold in all the shops, and known as mineral water. He was told
that a tumblerful of water from the Kiver Neva drunk before
breakfast would have the same effect as a tumblerful of Crab
Orchard salts water has in Kentucky. The lower classes, he said,
drank the river water and the common spring water of the coun-
try ; besides this their food was not to be compared with that of
the upper classes.

348 Trealmeni oj Chokra.

CHAPTER XVI.

Treatment of Cholera.

I think I have shown what cholera is. I think I have shown
clearly and distinctly the pathological conditions which consti-
tute it. It is a disease in which congestion of the great veins,
and of all their branches in which there are no^ valves, is more
excessive than in any other malady; greater even than in the
cold stage of congestive chills. Unless this condition of things
is considered and fully understood, it is altogether useless for a
man to attempt to account for or to remove the difficulties which
this congestion involves. All speculations as to the condition
of epithelial covering of the alimentary canal; all speculations
as to animal or vegetable parasites entering the body either
through the stomach or lungs ; all speculations as to the condi-
tion of the nervous system, amount to nothing if this venous
congestion is not fully considered and clearly understood.

I have noticed the work of Dr. Chapman somewhat exten-
sively, because I believe that the practice which he has introduced
promises to do great good in the treatment of diseases. I differ
from him totally as to his views on the nervous system. I be-
lieve that since the days of Magendie and Sir Charles Bell nothing
has been discovered concerning the nervous system which has
possessed in itself much practical value. I do not pretend to
say that these discoveries have not advanced our knowledge of
the nervous system; but the two things about which most has
been said and written have had altogether too much importance
^ attached to them. I allude to the supposed discovery of the vaso-
motor nerves and reflex action. Since the days of Magendie and

Treatment of Cholera. 349

Sir Charles Bell it has been known, if it was not known before,
that when a horse kicks or an athlete knocks down his rival, that
the muscles are made to contract and to expand by and through
the power of certain nerves. As it was known long before their
day, perhaps, that the blood-vessels are capable of dilatation and
contraction; in other words, that they do dilate and contract, it
could hardly, I think, be called a discovery for a physiologist to
declare to the world that there were certain nerves which caused
•these blood-vessels to dilate and to contract. The so-called dis-
covery of the vasomotor nerves is not, I think, made out with
any clearness or distinctness.

A great deal has been said and written about reflex action.
What does it amount to? Many a blooming beauty returning from
the ball-room, when the deceitful moonlight caused her to suppose
that a puddle of freezing water was a broad, white stone in the
path, has had her silken slipper thoroughly saturated, the result
of which was a pneumonia or some other equally serious malady.
This was reflex action. Dr. Charles Caldwell used to say that it
was sympathy; and he tried to make the class understand that
the pneumonia would have followed the almost freezing of the
feet if there had been no connection of flesh and blood between
the parts. The nervous system may be compared to light. When
the rays of the sun are admitted into a darkened chamber through
a round hole or aperture, a white spot is observed upon the floor
corresponding to the size of the aperture; but if you place a
prismatic glass in the opening, the rays of light are separated,
and you have the seven colors of the rainbow — red, orange, yel-
low, green, blue, indigo, and violet — in the place of the white spot
on the floor. This white spot, or undivided light, may be said
to represent the nervous system in animals of the lowest develop-
ment. The whole nervous system in them is altogether mixed up
and is indivisible ; but as you advance through radiates, mollusks,
articulates, and vertebrates you have little by little some sort of
separation ; after a while nerves which seem to control organic
or vegetative life, and nerves of animal life, until you arrive at
man and woman, in whom the nervous system is so wonderfully

350 Treatment of Cholera,

divided and separated that the whole nervous system can be dis-
sected by the scalpel almost without the aid of a microscope.
But as the colors formed by tne prismatic glass and by the rain-
bow so approximate and blend together that it would be hard to
tell where the one begins and the other terminates, so it is in
the nervous system physiologically and pathologically considered.
The union of the nerves of organic and animal life, and also the
union of these with the nerves of the special senses, and the union
of all of them with the brain, is so intimate that you can not*
touch or affect any one part of the entire system without influ-
encing more or less the whole. Sometimes a limb is crushed,
and yet the skillful surgeon preserves it, and after a few months
it seems to be as sound and as healthful as ever! Sometimes the
surgeon has to amputate, but, notwithstanding, after a few months
an artificial limb is worn with comfort and pleasure. In neither
instance was there any disturbance of the nervous system. Some-
times, again, a mere scratch or accident, which did not attract at-
tention, causes that terrible and mysterious malady called tetanus.
Sometimes what we see, sometimes what we taste, sometimes what
we smell, and sometimes what we hear, causes nausea and vomit-
ing, and even syncope. How often has a fetus in utero been
marked by an indelible spot, the result of mental emotion ? All
these are reflex actions, and they are all eqally mysterious. So is
it also in the use of therapeutical agents. I, in common with
other physicians, use many medicines to act upon the nervous
systeru; but it is, after all, only a judicious empiricism. , When
the most terrible of all the forms of nervous derangement takes
place, I mean insanity, the very ablest physician is often at his
wits' end.

Take away from lunatic asylums all hygienic rules, which have
done so much to preserve and to restore health under all condi-
tions; take away from them the necessary discipline and restraint;
take away from them the control and the decision of the kind but
firm superintendent ; take away from them the loving care of affec-
tionate and sympathizing women, and what have you left which
contributes to the recovery of the patients? I answer, nothing-,

Treatment of Cholera. 351

or almost nothing. Black is the absence of all color, as total
darkness is the entire absence of light ; yet in the arts we call
black a color, and it is often intermixed with red, orange, yellow,
green, blue, indigo, or violet to produce shades of color; but its
presence would mar the beauties of the rainbow or the colors of
the prismatic glass. So in the animal economy. Something
changes the healthful condition of the nervous system into a
morbific one. It may be that this something produces what
is called facial neuralgia. It may be that it produces epilepsy.
It may be that it produces insanity. It is as yet all mystery.
Neither the scalpel or the microscope has yet explained it. The
same thing is true of therapeutical agents addressed to the nerv-
ous system.

Dr. Chapman believes that the spinal ice-bags will cure chol«
era. I do not doubt the value of it in some cases. He supposes
that an impression is made by the ice upon the ganglia of the
sympathetic nerves. The sympathetic nervous system is too far
removed from the surface of the back along the spinal column
to be affected by the ice, except so far as the ice affects the action
of the heart and respiration, and the nervous system generally.
This system of nerves is outside the long spinal column and may
be said to be within the cavities of the abdomen and chest, going
up to the brain over the longus colli muscle. It is located within
the warmest parts of the human body, and in cholera patients
great heat is complained of within the abdomen. That the appli-
cation of bags of ice or of hot water to the spinal column doe&
affect the action of the heart and respiration, I do not doubt.
Many persons are greatly refreshed and invigorated by a cold
bath. There is in them full reaction, accompanied by a glow
over the surface. Others are chilled. In them reaction is very -
slow, and the bath does them more harm than good. All such
should avoid cold baths. But this is a matter which has to be
determined by trial. I have referred to Dr. Curriers cold-water
practice in fevers. I have tried it in many cases, and it is of all
sorts of practice the most delightful. But the cold water is here
applied where the skin is burning hot and the patient has a rag-

352 Treatment of Cholera,

ing fever. There is no remedy so prompt, so efficacious, and so
permanent as a cold bath in such cases. But it is a different
thing in individuals, sick or well, where the temperature is at
the normal standard; and when the temperature is below the
standard of health, then great caution must be used in the appli-
cation of cold water or ice.

Dr. Chapman's practice was made known to the public some
eight or ten years ago. The external application of ice to chol-
era patients was tried in St. Louis before he made his first publi-
cation on the subject. I believe the results were encouraging.
I will speak of one cholera case in which I used cold water after
having given my particular views about the treg-tment. There is
another therapeutical agent which is supposed to act — as Dr.
Chapman thinks the ice-bags act — that is, to effect the dilatation
and contraction of the arteries. I refer to belladonna or atropine.

Dr. R. Saunders, of Paducah, Ky., was the first physician, I
believe, to introduce this practice in the treatment of cholera.
His method was by hypodermic injection.

In a learned and admirably written paper by Mrs. Mary C.
Putnam, M. D., of New York City, on Belladonna and Atropine,
I have not been able to discover any thing as to the therapeutical
effects of the drug when administered to patients. I can only
learn from the paper that the effects of the drug upon the heart's
action are uncertain and irregular, seeming to depend upon the
size of the dose and the way in which it is administered.

John M. Scudder, M. D., of Cincinnati, an eclectic physician,
in his work on Specific Medication, page 85, says, "The specific
use of belladonna is as a stimulant to the capillary contraction,
especially of the nerve centers, a remedy opposed to congestion.
My attention was first drawn to it by an article from Brown-
Sequard, giving the results of his experiments with the drug, stat-
ing that with the microscope he had seen marked contraction of
the capillaries following its use.

" It at once suggested itself to me, that if it would cause capil-
lary contraction it would be the remedy for congestion ; and I at
once commenced experimenting with it in this direction. I will

' Treatment of Cholera. 353

recall my first marked case. A boy about eight years old, suf-
fering from malignant rubeola. The entire surface was swollen
and dusky ; the eyes dull ; the pupils dilated ; the face expres-
sionless; breathing labored; and wholly unconscious for forty-
eight hours. The administration of belladonna alone (in small
doses) was sufficient to restore consciousness, and a free circula-
tion, with good appearance of the eruption, in twenty hours.
The evidences in its favor rapidly accumulated, so that in eight-
een months I used it with a feeling of almost certainty for this
purpose."

Sydney Ringer, M.D., in his Handbook of Therapeutics,
page 443, says, " The first effect of belladonna on the pulse is to
increase its quickness, fullness, and force to the extent even of
fifty to sixty beats in a minute. This condition of the circula-
tion continues till the tongue and mouth become moist and
clammy, when the pulse diminishes in frequency, and loses in
strength."

"Dr. J. Harley considers belladonna a powerful heart-tonic,
adducing in proof the power of this drug to reduce the frequency
and to strengthen the beats of the heart when weakened by
disease."

Dr. Waring, in his Practical Therapeutics (already referred
to), says, " The following are the effects of a full dose of bella-
donna : Acceleration of the pulse from twenty to seventy beats,
with a slight increase of its volume, and a considerable increase
in the force of the cardiac and arterial contraction; a general
diffusion of warmth throughout the cutaneous surface; a gentle
throbbing or heaving sensation in the carotids," etc., etc. (Page
120.) ....

'* In all conditions and diseases in which there is depression
of the sympathetic influence, such as syncope from asthenia, or
shock, or the collapse of cholera, in failure of the heart's action
from chloroform, or other cardiac paralyses, the subcutaneous
use of sulphate of atropia in doses of j \-q to ^^ grain is, accord-
ing to Dr. Harley, the appropriate and most hopeful means of
resuscitation."

23

354 Treatment of Cholera.

From all that I can learn of the therapeutical effects of bella-
donna and its preparations, I consider it worthy of farther trial
in the treatment of cholera. But, I think, great caution and
judgment will have to be used in experiments with it. If it has
the effect to remove congestion, it is certainly a remedy in the
right direction, for that is the thing particularly to be done.
The weight of medical authority seems to be, that it excites the
frequency and force of the heart's action ; but such influence
does not seem to be of long continuance.

Belladonna unquestionably arrests secretion in certain glands,
as the mammary gland for instance. Whether it arrests secre-
tion in all the glands I do not know ; but if it arrests secretion
in the liver, its secondary effect of arresting secretion would do
more harm than its first effect, of exciting the heart's action
could do good. From all that I can learn about the drug, I
am inclined to think, that its best therapeutical effects will be
found to follow small doses, with sufficient time between the
doses. Should I ever have to treat cholera again I will try it;
but I will use it in conjunction with calomel.

Knowing, as well as I do, that the "regular" medical profes-
sion have done, and are doing, more to prejudice the public
mind against the use of calomel in the treatment of cholera, as
well as of almost all other diseases, than the eclectics, the steam-
doctors, and all other isms have been able to do. I have refer-
red to belladonna in this connection because, if the medical read-
ers of this book agree with me in every thing else that I have
written, I do not suppose that many of them will be willing to
adopt my practice in the treatment of cholera. The prejudice
against it is too strong.

I think I have overturned the physiological theories, and the
conclusions drawn from pathological experiments, which are the
corner-stone and entire foundation of the new system of prac-
tice, which assumes to call itself scientific.

I am not willing that the sound principles, which I have so
clearly explained, should be rejected because I attach very great
importance to one particular medicine.

Treatment of Cholera. 366

Up to this time, I say that calomel is by far the most reliable
remedy in the treatment of cholera. If, however, any other
remedy, or method of treatment, will do all that calomel does do
in restoring the healthy functions in cholera patients, I will be
among the first to acknowledge their value.

During the past year, both in Kentucky and elsewhere, fully
one half of the cholera patients died. In some localities the
mortality was much greater. So far as I have been able to learn
the medical profession seem to prefer trying almost every thing
else before calomel. As I believe they will still do it, I will
refer to another method of practice.

Dr. John Mackintosh, from whose book I have made lengthy
extracts, advocated bleeding in the cold stage of fevers. At page
104, vol. 1, he says, "Bleeding in the cold stage will, in a great
majority of instances, cut it short; in fact, it will rarely fail in
stopping the existing paroxysm, and on many occasions it has
prevented a return of the disease to which the patients had been
long subject, and by which they were nearly worn out. It is
difficult to determine what quantity of blood it will be neces-
sary to draw in any given case; sometimes it requires twenty-
four ounces. I have known three ounces to suffice, and in one
case an ounce and a half produced the full effect. The larger
the orifice in the vein, the greater is the chance of arresting the
disease at a small expense of blood; but in many cases the oper-
ation is attended with considerable difficulty, from the convulsive
tremors which affect the whole body. I was once successful in
arresting the disease by bleeding in a cold stage which had lasted
twenty-six hours, but I regard this as an extreme case. The
blood sometimes only trickles down the arm ; and as the system
is relieved the stream becomes larger and stronger, till at last it
springs from the orifice, and frequently before six ounces are
taken the patient will express relief from violent pain in the
head and loins, and it will soon be observed that he breathes
more freely. The tremors become slighter and slighter; and by
the time a few more ounces are abstracted they will cease alto-
gether, and with them will vanish the painful sensation of cold.

356 Treatment of Cholera,

The pulse will be found stronger, and a gentle moisture will be
observed on the body. If the patient be properly managed with
respect to bed - clothes, neither the hot nor sweating stage will
in general follow/^

Dr. Mackintosh gives some interesting cases, to which I would
call the attention of the reader.

Ordinarily it is not necessary to bleed in the cold stage of
fever; but there are some cases of congestive chills, cases des-
perate in themselves, in which I would bleed and give the patient
that chance for recovery where all other chances seem hopeless.

Ordinarily I would not bleed in cholera, but where all other
remedies fail, and where it is manifest that the patient will prob-
ably die, I would give him this chance.

The main thing to be done is to remove the venous conges-
tion. If you can effect only the beginning of this removal, re-
newed action of the heart and free respiration will follow.

Increased action of the heart and deep and full inspirations
involve necessarily a free circulation of the blood. The genera-
tion of animal heat accompanies the restoration of these vital
functions.

I think there are fewer objections to bleeding in the cold
stage of cholera, and less risk to the patient, than in the cold
stage of miasmatic fevers. There is in cholera less disturbance
of the nervous system. It seems rather to be prostrated, i. e. in
the majority of cases. The tremors, and shaking, and chattering
of the teeth, which are symptoms so marked in agues, are not
present in the cold or collapse stage of cholera.

I never bled but one cholera patient. It was in 1849. He
was forty-five years old, and had had a severe attack of cholera in
1833. He was salivated at that time. I was his family physician
for four or five years prior to 1849. The man was occasionally
sick, and I noticed that whenever he was sick he appeared to be
salivated, though lie took no mercury, and I never gave him a
dose under any circumstances. His attack of cholera was sudden
and violent. The rice-water discharges were excessive, and his
limbs were becoming cold rapidly. Not being willing to give

Treatment of Cholera. 357

him calomel, I had to do something else. I placed his feet in a
bucket of hot water containing mustard and salt, the water com-
ing up to the calves of the legs, and after a few minutes applied
a bandage around each ankle, and then divided the largest vein
I could see in each foot, and then placed his feet again into the
bucket of hot water. How much blood he lost I could not tell,
but I bled him until he had a full, strong pulse. He was sitting
in a chair during the time. Full reaction, with warmth, speedily
followed. There had been no vomiting. The rice-water dis-
charges were arrested. As soon as I had placed him in bed I
gave him twenty grains of quinine in some brandy and water.
I had no farther trouble with this case. He continued to drink
the brandy and water. This man died in Lexington, Mo., in 1879.

The only explanation which can be given for this man's recov-
ery is that the bleeding removed the congestion which obstructed
the action of the heart and which prevented free respiration. I
repeat that I think the remedy worthy of farther trial in cases
which are apparently desperate. But if bleeding is tried I would
recommend that my method of bleeding be adopted. It has many
advantages over opening a vein in the arm. This is a remedy,
however, which it will not do for a physician to prescribe. When
practiced the physician should all the time keep his fingers on the
pulse in the arm. If it becomes stronger and fuller, he may be
certain that the loss of blood is aifording relief. So soon as the
pulse becomes strong and full the divided veins ought to be tied
up. If, however, the pulse became weaker and more frequent
after the blood began to flow the veins should be immediately
tied up and the patient placed in a recumbent position.

But for the particular circumstances spoken of in this case I
would have given the man calomel.

Bleeding in cholera is a method of treatment which no phy-
sician should practice unless he understands clearly what are the
pathological conditions which constitute the disease ; unless, in a
word, he fully comprehends what venous congestion means, what
it involves, and what are the healthful consequences which will
follow its removal.

358 Treatment of Cholera,

The steam - doctors say that they cure cholera by giving a
lobelia emetic. They give the lobelia in a tea made of what
they call composition powder, which is highly stimulating and
very diffusible. It is well known to physicians generally that
medicinal emesis will often arrest nausea and vomiting caused by
sickness. I know nothing about this practice; but if by it they
succeed in removing the congestion and in arousing the heart
and lungs to vigorous action, it is another remedy in the right
direction.

Mustard and salt emetics were used here by the regular phy-
sicians in the treatment of cholera in 1833. Many thought well
of them ; others said that they did very little good. Very few,
if any, physicians gave mustard and salt emetics during the prev-
alence of cholera in 1849. I do not doubt that a prompt emetic
would, in some cases, do good; but I do not now recollect ever
having given one to a cholera patient. If I were to give an
emetic I would follow it with a dose of calomel as soon as the
stomach became quiet after vomiting. But calomel is the medi-
cine upon which I chiefly rely in the treatment of cholera; in-
deed, I consider it worth all other remedies put together.

There is, perhaps, no place on the globe in which calomel has
been given in the enormous quantities given here. Dr. Louis
Marshall, of Virginia, but for many years a resident of Woodford
County, in this state, claims to have been the first physician to
give calomel in doses of from a dram to an ounce; but Dr. John
Esten Cooke is the physician who has received all the credit, and
all the blame, for this practice. He was practicing here in 1833,
when the cholera appeared. He had treated fifty-odd patients,
when he had a bone broken, which confined him to his house
during the remainder of the epidemic. He published a report
of these fifty-odd cases, nearly all of whom recovered. Com-
mencing in smaller doses, he very soon gave calomel in ounce
doses, which were frequently repeated. Sometimes he gave two
ounces and over. The same practice was pursued by Dr. Cooke's
son-in-law. Dr. Henry Hopson, about six miles from this city.
This excessive use of calomel was a matter of constant discus-

Treatment of Cholera, 359

sion. The writer was not living here at the time. When the
cholera appeared here in 1849 Dr. Cooke's practice was again
discussed, and I soon learned that there were sixteen persons
living here then who had taken calomel in frequently-repeated
ounce doses in 1833. I knew each of these individuals, and can
testify that they enjoyed as good health as any other persons in
the community. In 1865 some of them were still living here,
and enjoyed good health.

There never was, in my opinion, a greater mistake or more
unfounded prejudice than the supposition that calomel, given in
large doses to cholera patients, is followed by bad consequences.
There are many powerful drugs which physicians use in very
large doses. Physicians often boast of the enormous quantities
of opium, and its preparations, which they have prescribed. The
same thing is true as to many narcotics and so-called anodynes.
I have given, and hundreds of physicians have given, a pint of
the best French brandy to delicate females who were flooding to
death in child-bed, and not only with the effect of saving their
lives, but also with this noticeable fact, that there was not as
much evidence of intoxication as an ounce of the brandy would
have produced upon them under other circumstances.

If calomel is of any use at all in the treatment of cholera,
why should not the same rule apply to the dose of it which
applies under other circumstances to opium, to narcotics, and
anodynes, and to alcoholic stimulants ? • The whole system is
in a torpid condition, and it requires a powerful remedy of some
sort to arouse it. There are a " thousand and one " remedies to
cure cholera.

After the cholera had disappeared from Cincinnati in 1866 I
read the report in one of the Cincinnati papers which purported
to be made by homeopathic physicians. The report said that
they had treated over twelve hundi!«ed cases and had not lost a
single case. Intending to be respectful to these gentlemen, I am
bound to say that the only explanation which can be given of so
remarkable a report is that they excluded from it all the cases
which died, on the ground, perhaps, that the fatal cases were past

360 Treatment of Cholera,

recovery when first seen. The same thing may be said of the
"thousand and one" remedies to which I have referred.

There are all sorts of explanations as to the perfect success
of every other system of practice except that of the "regular"
profession, which is dubbed " allopathy."

Inasmuch as in Christendom the "regular" profession treats
nine tenths of the cases, under all forms of human malady, they
have constantly charged upon them all fatal cases, let the circum-
stances and conditions be what they may. I know that many
cholera patients have recovered who were in profound collapse.
Physicians of the first standing in this country and in Europe
testify to the same fact. Some of these cases which recovered
did not take calomel.

The question will be asked, what becomes of the calomel
when given in dram doses, and in larger doses? One thing is
certain, it is not absorbed. Ipecac is an emetic; aloes and rhu-
barb are cathartics; opium produces sleep; and calomel, I main-
tain, excites the secretion of bile; but why either one produces
the effect w^hich is known to follow its administration, is past
finding out.

It is sixty years ago since Dr. Louis Marshall was a practic-
ing physician. He died since the war, about ninety-five years
of age. He told me that he had frequently collected the calo-
mel and washed it after it had passed through the bowels, and
then given it again.

At that time it took weeks to get goods from Philadelphia,
and the economy and saving practiced then can hardly be con-
ceived now. I do not doubt that calomel given in large doses
passes through the bowels as calomel. There can be no greater
mistake than to suppose that calomel given in large doses ex-
hausts or prostrates when it is administered to patients whose
vital functions are as torpid* as we know them to be in collapse
or approaching collapse of cholera. There are some other con-
ditions of human maladies of a different class concerning which
the same thing is true.

What I well know about the treatment of cholera is this,

Treatment of Cholera. 361

that where the patients take calomel in doses of from one half
dram to one and two drams they recover in a very short time,
and they are rarely troubled with consecutive fever. The Ken-
tucky physicians generally rely on calomel as the most efficient
remedy in the treatment of cholera; but a majority of them
prefer giving it in small doses frequently repeated. I know
some eminent physicians who give one grain every five minutes.
Unless there is a reliable nurse so frequent a repetition of med-
icine will not be attended to. The dose with many physicians
is from ten to twenty grains repeated every hour or two. A
larger dose, say from thirty to eighty grains, has many advan-
tages. I have very seldom given more than eighty grains at a
dose, though I would not hesitate to do so. Where there is
vomiting a large dose will much more certainly arrest it than a
small one. Where only a few grains are given they are easily
thrown up. The weight of a large dose will cause a part of it
at least to be retained.

Those who have never given calomel in large doses to cholera
patients, would be astonished to see in how short a time it ar-
rests the rice-water discharges. Among the common errors as to
the medicinal uses of calomel, there is none more common than
this, viz. that calomel given in large doses will run off on the
bowels. Such is not the fact, even as to twenty-grain doses, not
only in cholera but in other diseases; and the larger the quan-
tity given the greater the necessity is there for giving castor oil,
or something else, to work it off. Another advantage possessed
by large doses is that they almost never salivate.

Again the prompt removal of all the bad symptoms seems to
me to depend greatly upon the size of the dose. But the ques-
tion will be asked by the intellectual general reader, why give
calomel at all to cholera patients? Know not, they will say,
that Dr. Hughes Bennett and others demonstrated that calomel
does not cause the liver to secrete bile? Have not all the learned
physiologists in the world proved that the bile when secreted
and poured out into the duodenum is immediately reabsorbed,
and goes back again into the blood of the portal veins? Have

362 Treatment of Cholera,

they not proved that the bile is not an excrementitious substance,
and that it forms no part o-r parcel of the feces ? Have they not
proved that the kidneys are the organs whose special function it
is to remove effete matter from the blood? Yes, they have at-
tempted to prove all this, and if there was one word of truth in
what they teach on these subjects, it would be impossible to ac-
count for the fact, a fact about which there can be no dispute,
that calomel given in decided doses does arrest all the bad symp-
toms of Asiatic cholera, and, I will add, cholera infantum, more
promptly and certainly than any other remedy. I not only
know, from personal observation in hundreds of cases, that such
is the fact, but I also know that there are scores of physicians in
Kentucky and other parts of the Mississippi Valley who will
testify to the truth of this fact. These physicians are gentlemen
of the first intelligence and highest character, and they have had
abundant opportunities to know the facts.

Homeopathic medication, practiced according to Hahnemann,
would make no more impression on a man in the cold stage of
cholera than would a certain something make in the manuring
of a ten-acre field, as President Lincoln said to the committee
of homeopathic physicians who called upon him to present their
claims for appointments as surgeons in the army during the war.
Were Congress to appoint a corps of scientific engineers to re-
build the levees, to remove snags and other obstructions, and to
open the channel of the Mississippi into the Gulf of Mexico;
and were this committee to start forthwith to the Rocky Moun-
tains, there to examine the little rivulets which go to form the
first springs which are the beginnings of the mighty Missouri,
as a necessary preliminary preparation for their work on the
mighty torrent of the Mississippi, that corps of engineers would
act about as wisely as do the physicians who expect to learn how
to treat cholera by microscopic examinations of the desquamated
epithelial lining of the bowels, which is washed away in the
rice-water discharges ; or by chemical analysis of the rice-water
discharge itself.

Dr. Vaughan very correctly said, in his letter to me, that the

Treatment of Cholera, 363

medical profession did not seem to know any more about cholera
to-day than they did twenty or thirty years ago. Tiie mortality
remains iabout the same. It is because the teaching of the med-
ical schools actually prevents men from understanding what the
disease is. And when they come to propose a remedy they do
not know what it is they wish to accomplish. Of course, they
want to cure their patients, but how to go about it they do not
know. The hearths action has to be aroused, but alcoholic stim-
ulants will not do this. The patient must be made to take
deeper and fuller inspirations, so as to convert the thick, dark-
ened, venous blood into arterial blood; but there is no direct
way to compel the lungs to act except by medicinal vomiting,
unless Dr. Chapman's ice-bags will rouse to more vigorous ac-
tion both the lungs and the heart. His practice, and the emetic
practice, are both worthy of farther trial.

The rice-water discharges have to be arrested; but neither
opium nor astringents will arrest them. The whole body, par-
ticularly the limbs, have to be warmed; but artificial heat is
abhorrent to the patients, and exerts not the slightest influence.
Mustard plasters only torment, and do not a particle of good.

If opium accomplishes any thing in arresting the rice-water
discharges, it narcotizes the whole system, and locks up the
secretions, particularly those of the kidneys and liver; and it
is not possible for a man to recover from cholera until the bile
begins to flow from the liver, and the urine to flow from the
kidneys.

No man ever saw a cholera patient begin to improve until
after the bile appeared in the alvine discharges, if there were any
discharges. It matters not what sort of practice the patient has
been subjected to, the fact just stated is true, and will continue to
be true for all time. We are then shut up to the necessity of com-
pelling the liver to secrete bile, if we would remove all of the diffi-
culties just referred to. I do not believe that any medical writer
denies the fact that the liver has ceased to perform this function
when the rice-water discharges begin to pass ofl*. There can be
no doubt of the fact. It is not to be supposed that the liver is

364 Treatment of Cholera.

diseased when it is only functionally unable to secrete bile. It
is necessarily congested in the cold stage of cholera.

It is constantly said by medical men who know nothing about
the liver, though they think they know every thing, and who do
not really know what congestion means, that it is useless to give
remedies to act upon the liver, because, as they say, there is no
disease of the liver. The remark only shows their ignorance,
because when the liver is really the subject of a lesion, remedies
should be used which act indirectly upon it, and not remedies
which act directly, as calomel, for instance. The thing particu-
larly to be done, by compelling the liver to secrete bile, is, first
and foremost, to remove the congestion of the portal veins.

As once befqre stated, so soon as the liver ceases to secrete
bile, which is the function it is constantly at work at in health,
the blood simply passes slowly through it into the hepatic veins.
But reestablish its functions, and there is at once, and immedi-
ately, a more rapid circulation of the blood through the gland ;
for all glands attract blood when actively secreting. So soon as
this active circulation of the blood through the liver begins, the
congestion of the portal veins is correspondingly removed. No
physiologist can deny this. It is the enormous congestion of
blood within the abdominal cavity which furnishes the vast
amount of serum thrown off by the rice-water discharges. Re-
move the congestion, and you will arrest the rice-water dis-
charges. Besides, the bile poured out into the duodenum is the
best and most effectual astringent that was ever applied to the
mucous membrane of the bowels. You husband the failing
strength of the patient by arresting the rice-water discharges in
this manner, but you do not do this by vesting them with opium
or astringents while the liver still remains torpid; for then the
condition of the blood has not been altered, and it is becoming
more and more, every minute, a materies morbi. It is the office
of the liver to separate this excrementitious substance (the bile)
from the blood, just as it is the office of the lungs to separate car-
bonic acid from the blood. Both agencies purify it, and the arrest
of either of them is fatal to life. When the locomotive moves,

Treatment of Cholera. 365

every car attached to it moves also. So when the liver begins to
act vigorously the lungs also begin to act more efficiently in the
performance of their functions. The healthful action of both
together soon places the blood in its natural state. The heart,
lying between these two organs, is soon relieved from the load
which oppresses it, and the circulation of the blood soon becomes
free and active, carrying warmth, by its motion, to every part of
the body. The removal of the abdominal congestion, effected
through the vigorous action of the liver, relieves the kidneys of
the congestion which oppressed them, and they commence at
once to secrete urine, thus removing from the blood other poison-
ous elements.

ISTow will calomel do all this in cholera cases? I say that it
will when given in sufficient quantities; and I also say, that of
all the drugs known to the physician, calomel can be given in
larger doses than any other one, not only with the certainty of
not doing the patient any harm, but also with the certainty of
doing him great good.

When the cholera was in Lexington and in this neighborhood,
in 1833, many a patient took a half pound or more of it, and
yet they lived in the enjoyment of good health for many years
afterward. Perhaps they took a great deal more than was neces-
sary, but the medical profession and the world learned with what
perfect. safety these enormous quantities could be taken. Ire-
peat again, that calomel given in large doses does not salivate.
It simply passes off through the bowels, leaving no bad conse-
quences. When the human body becomes mercurialized, it is the
result of small doses continued for a long time.

Any one who would understand my views as to the treatment
of cholera, must first read this book from the beginning, and
consider well every proposition which I have discussed. I have
endeavored to make each chapter intelligible in itself, but each
and all of them must be clearly understood before the reader will
be able to appreciate the chapter on cholera. I am entirely satis-
fied that I am correct as to the nature of the bile, and the func-
tions of the liver; but whether I am or not, no medical man

366 Treatment of Cholera,

denies that it is the healthful office of the liver to separate bile
from the blood; and every one who knows any thing about chol-
era, knows that this function is suspended almost as soon as the
attack of cholera can be said to have begun.

I admit that congestion, which soon follows, may possibly be
removed by belladonna, judiciously given; but of this I know
nothing.

I admit that the congestion can be removed by medicinal
vomiting; but of this I have no personal knowledge.

Dr. Chapman says that the ice-bags remove congestion and
restore the healthy functions. I have no reason to doubt the
truth of his statements; but if all that he assumes for the ice-bag
practice is correct, it seems to me that the practice would have
been more generally adopted in London, if nowhere else.

I admit that congestion may be removed by blood-letting. I
have given a single case.

No one who has read the report of post-mortem examinations
of cholera subjects made by Dr. Mackintosh and others, to which
I have referred, can deny that there is a profound congestion of
the vena cava and its branches, and particularly of the abdomi-
jial veins which go to make up the portal circle. This congestion
has to be removed by one of the methods just above referred to,
or by causing the liver to secrete bile. This is, of all others, the
most direct method by which the congestion can be removed.

The secretion and pouring out of bile not only relieves the
congestion promptly and certainly, but it possesses this particular
advantage over all other methods, viz. that it separates the eifete
matter from the blood, which is so rapidly increasing because of
the destructive metamorphosis which is energetically at work in
the cholera patient. By the removal of this effete matter — in
the form of bile — every organ in the body has a purer blood fur-
nished to it. It is a thing the beneficial effects of which it would
be difficult to calculate. It is really astonishing in how short a
time the whole condition of the patient is changed as soon as the
bile begins to flow. How absolutely necessary, then, is it that a
physician should have a correct knowledge of the functions of

Treatment of Cholera. 367

the liver, and of the bile and its uses, if he would undertake to
treat cholera understandingly. If he has not this knowledge it
is all guess-work. It is because physicians generally have not
this knowledge that there has been so great a multitude of fan-
ciful conjectures as to the modus operandi of some particular
remedy. It is learned nonsense, expressed in big words.

While I maintain that the secretion and pouring out of the
bile relieves the congestion more certainly, more promptly, and
in a more beneficial manner than any other method, I also main-
tain that calomel stands incomparably superior to every other drug
in its power to compel the liver, or to excite the liver, to separate
the bile from the blood and to pour it out into the duodenum.
While this current of bile is passing into the bowels there is also
a free current of purified blood passing from the liver to the vena
cava through the hepatic veins. This necessitates the return of
purer arterial blood to the liver through the hepatic artery. By
a supply of healthy arterial blood the liver is better enabled to
perform its normal functions. The heart itself is stimulated in a
healthful way to more regular and vigorous action, because the
blood which is returned to it through the ascending vena cava
has had a large part of the effete matter removed from it by the
liver. In like manner a different quality of blood is sent to the
lungs through the pulmonary artery. In consequence of this
the blood is more thoroughly oxygenated as it passes through
the lungs. Neither the heart nor the lungs would have taken on
healthy action had not the liver been compelled to separate the
bile from the blood.

The removal of the abdominal congestion, as I have before
said, immediately relieves the kidneys of the congestion which
oppressed them, and a more healthful and freer current of arte-
rial blood being sent to them from the left side of the heart, they
at once commence to secrete urine. This general restoration of
the healthy functions of the liver, of the heart, of the lungs, and
of the kidneys, relieves at once and completely the morbid pro-
cesses which were at work in the mucous membrane of the ali-
mentary canal; and, added to this, we have the healthful influence

368 Treatment of Cholera,

of the bile upon that surface. Saliva is not more necessary to a
clean, sweet, and healthy mouth than is the presence of the bile
to a healthy condition of the mucous surface, from the stomach
to the anus.

It is well known to every intelligent medical man that there
are no two organs which sympathize with each other so closely as
the liver and the skin.

When the one is healthy, the other is healthy. Carrying out,
then, this chain of effects from the liver, restored to the healthy
performance of its functions, in the cholera patient we immedi-
ately observe that the skin, too, is beginning to perform its health-
ful functions. Correspondingly with these agreeable changes,
life-restoring in themselves, we find that the congestion of the
brain is also removed, and the whole nervous system is at once
itself again. General, healthful warmth, not feverish heat, dif-
fuses itself throughout the whole body, resulting from the free
circulation of a current of healthy blood.

The digestive organs, one and all of them, are now in a con-^
dition to convert the food into blood. It is food alone, after
the removal of the morbid symptoms, which can restore strength
and lost tissue to the body.

The spleen having been relieved from the congestion which
oppressed it, is now ready to pour rejuvenated blood into the
portal veins, by the conversion of the food passing through it,
into albumen and fibrin.

The kidneys also go to work at their allotted duty, viz. the
removal of certain excrementitious parts of the food, which
ought to pass off from the body through the urinary ducts.

The lymphatics, also, throughout the entire body, are again
enabled to perform their normal and healthy functions.

I again repeat, that cholera patients treated in this way almost
always recover without any consecutive fever. But the question
may be asked, and correctly asked, have not cholera patients
recovered even from the cold or collapse stage who took no calo-
mel? I answer, that there is not a particle of doubt that they
have so recovered.

Treatment of Cholera. 369

Let us examine how.

The steam-doctors claim that they cure their patients by vom-
iting them; and the salt-and-mustard-emetic practice has been
resorted to by many regular physicians.

If the reader will refer to the chapter on Emetics, he will see
that it was the common practice in the tide- water region of Vir-
ginia to give an emetic so soon as the first symptoms of a chill
or ague manifested themselves. The first effect of an emetic
properly given is to arouse the heart's action and to cause freer
respiration. These are effected by the mechanical action of vom-
iting alone. But very soon after the bile is vomited up, showing
that the liver is certainly at work. A part of the bile poured
into the duodenum certainly passes downward, that being its ordi-
nary and natural direction.

If I were to give an emetic to a cholera patient, I would cer-
tainly give calomel afterward; but, understanding thoroughly
what it is that is to be done, I can readily see that patients might,
and no doubt could, recover without the calomel. It is a thing
well known to all medical men, of every school, that those of
them who are entitled to be called physicians have the faculty
or the ability to manage their particular system better than any
body else could. You may take the first regular physicians in
the United States, or in Europe, who agree generally both as to
the principles and practice of medicine, and yet you will find
that they will treat successfully any one, or all of the most
marked forms of disease after a somewhat different manner.

In cholera cases we must know and understand what it is we
have to do. The manner of doing it may be somewhat varied.
In the patient whom I bled it was the pouring out of the blood
from the feet in the bucket of hot water which removed the con-
gestion. The removal of this congestion enabled both the heart
and lungs to perform healthfully their natural functions. The
congestion of the portal circle and of the liver being of course
removed, that organ (the liver) was again enabled to separate bile
from the blood, which is as much its constant function as the sep-
aration of carbonic acid from the blood is the constant function

24

370 Treatment of Cholera,

of the lungs. The bile separated in the liver and poured into
the duodenum played an important part in the arrest of the rice-
water discharges. The twenty grains of quinine given to this
man was a permanent tonic.

As to Dr. Chapman's method, I will have something more to
say in another place. To give my speculations as to the origin
of cholera, I would hazard the opinion that there is an efficient
cause, which is negative, and exciting causes, which are positive.
The negative cause is a deficiency of ozone in the atmosphere.
This deficiency of ozone is probably connected with an altered
condition of the electrical state of the atmosphere. Since the
discoveries of Maury as to the currents of the atmosphere, this
subject has claimed the attention of many scientific men ; but yet
it is far from being understood.

I suppose that there may be local currents within the area of
a square mile. We know that the breadth of a tornado is some-
times only a few hundred yards. Whirlwinds are sometimes
only a few feet in wddth. Now I suppose that there may be
atmospheric currents very limited in breadth which have a defi-
ciency of ozone. Individuals breathing these currents very soon
have the oxygenation of their blood arrested, and their systems
immediately become susceptible to the influence of the exciting
cause or causes, as improper food, bad water, or fright. The
combined action of the negative and positive causes produces all
that follows. There is, then, no lesion. The malady commences
in functional disturbance. The blood is at once altered, and all
the secretions are arrested.

Excluding poisons like prussic acid, excluding the bullet and
the dagger, and other external forces, I do not suppose that any
thing could be more quickly fatal than the total arrest of the
oxygenation of the blood in the lungs, and of the throwing off
carbonic acid from them. The individuals who died at INIuscat
and Teheran, Asia, in from five to ten minutes must have been
subjected to the total arrest of these vital functions. They may
have had to breathe currents of air totally deficient in oxygen-
ating power. This deficiency is, of course, variable, and hence

Treatment of Cholera, 371

a longer or shorter interval would elapse before diiFerent individ-
uals would be struck down. No doubt there are many other
conditions which would assist the causes already named in cre-
ating the malady. Among these are intemperance, filthy and
crowded apartments, imperfect sewerage, etc.

Dr. Mackintosh discovered, by his post-mortem examinations,
that a majority of the subjects presented evidences of chronic
maladies, which had already weakened their systems. Of course
it would be more difficult to cure such cases.

As to my personal observations and experience in the treat-
ment of cholera, I will only speak of the epidemic which pre-
vailed here in 1849. The first cases occurred in June, and it
raged for nearly two months with considerable violence. The
first case that I ever saw was at the lunatic asylum, just within
the city limits, where it prevailed for some weeks before it was
in the city proper. The man was in collapse, and died.

I can not say how many cases of cholera I have treated, as I
kept no memorandum of them. All that I know is, that the
cholera, like all other epidemics, excluded almost every other
form of disease, and that I was continually going, night and day,
for over six weeks. A large number of the patients attended by
me lived in the city, but there was hardly a day that I did not
go to the country to see a cholera patient. Having never seen
a case before, and while I had every confidence in Dr. Cooke's
calomel practice, I was yet not indisposed to try more mixed
prescriptions.

Dr. Cartwright, of Natchez and of New Orleans, had been very
successful, it was said, in the treatment of cholera. His prescrip-
tion was, calomel grains xx, capsicum, quinine, and Dover's pow-
der, aa grains v. This was a dose. It was to be repeated every
two hours until there were evident signs of improvement. I
tried this prescription, except that I put thirty instead of twenty
grains into the dose, and found that it relieved the patients in
many cases. I was, at the time, the physician of three families
in the country, to which I would refer.

In two of these families there were fifty-odd individuals, white

372 Treatment of Cholera.

and black, a large majority being negroes. As they lived some
distance from the town they said to me that my town patients
might prevent me from giving them proper attention if the chol-
era appeared among them, and they therefore wanted me to put
up medicines with directions for them. I had a number of pow-
ders prepared containing each five grains of capsicum, five of
Dover's powder, and five of quinine, and thirty grains of calo-
mel. These I called powders number one. Powders number two
contained sixty instead of thirty grains of calomel. I directed
that powders number one should be given as soon as the diarrhea
commenced, and that if one dose was thrown up another should
be given immediately until it was retained.

They were to be repeated every two or three hours, according
to the progress of the case, which I explained to them. But if
powders number one did not arrest the rice-water discharges,
then they were to begin with powders number two, or sixty-
grain doses of calomel, and repeat them every two hours until
the patient was relieved. There was a number of cases on each
of these farms, but I did not have to go to see one of them, as
every case was promptly relieved by following the directions
which I had given.

On the other farm there were eighty -odd negroes and the
overseer's family, some half a dozen in number. I had the
same powders put up, and gave the overseer directions how
to use them. This farm being within three miles of the city, I
visited the patients. There were twenty - six cases of cholera
among the negroes, and one white man, the brother of the over-
seer. He went out from Lexington with the disease upon him,
and I will describe his case more particularly hereafter.

It is probable that I would not have seen as many cases
among the negroes had I not been visiting this man, for the
overseer gave the powders as directed upon the first manifes-
tation of the disease. Every case recovered.

There was within a quarter of a mile of the negro-quarters
and overseer's house an Irish shanty. Five or six Irishmen died
of cholera in^that shanty. I never learned how they were treated.

Treatment of Cholera. 373

I think the success of the practice on these three farms shows
that Dr. Cart#right's prescription, with my addition to it, was a
very good one. Of course, in treating the twenty-six negro cases
on this farm, I did not confine myself to the powders referred to.
I so frequently found that these powders were rejected by the
stomach among my city patients that I did not very long con-
fine myself to them. I think it is an excellent prescription
where you are called to prescribe on the first appearance of the
diarrhea. But where the cases are sudden and violent, and espe-
cially where there is much vomiting, it will not do. I very soon
learned to put more confidence in calomel alone. It is true that
I used other remedies as auxiliaries, such as camphor and mint-
water, mixed with some astringent. In some cases these were
of service. I very soon abandoned mustard plasters. I thought
some cases were benefited by fly -blisters applied over the stomach
and bowels. I tried artificial heat in one case, by making the
patient, a negro man, lie on a pallet before a large wood fire. It
did him no good, and he said that he never felt the heat. In all
severe cases, where collapse was threatened, I commenced by
giving eighty grains of calomel at a dose, and repeated it every
two hours until the rice-water discharges were checked, and after
that every four hours until the bile passed off from the bowels.
In a large number of cases only two or three doses would have
to be given before there was a decided improvement, when the
intervals between the doses would be lengthened, and sometimes
the quantity would be diminished.

Physicians who never tried calomel in sixty- and eighty-grain
doses would' be actually astonished to see how promptly even a
single dose sometimes arrests the rice-water discharges; and,
entertaining the views which many of them do, they would be
no less astonished to see that the first thing produced, after the
rice-water discharges ceased, was about a gill of thick, viscid,
dark-colored bile. The bowels had been so completely emptied
by the copious and gushing rice-water discharges that it would
be difficult to conceive of what this dark - colored, gelatinous
stool is composed if it is not bile. I have no sort of doubt of

374 Treatment of Cholera,

the fact. But it will not do to stop giving calomel when dis-
charges of this character appear. The medicine *must be con-
tinued, though at longer intervals, and sometimes in smaller
doses until the discharges become of a rhubard yellow. The
length of the intervals, and the size of the doses, must be deter-
mined by the physician in attendance.

Dr. Cross says, in one of his articles, that he lost a cholera
case which he had no doubt would have recovered had he not
discontinued the calomel too soon.

Sometimes other medicines may be combined with the calo-
mel to keep up the action of the liver; among the best of these
is the compound extract of colocynth.

Five-grain pills, composed of equal parts of the sulphate of
iron (reduced to an impalpable powder), of Turkey rhubarb, of
socotrine aloes, and of calomel, are a good remedy in such cases.
They are somewhat astringent, while they are slowly cathartic.
I give from one to three of these pills at a dose. But sometimes
you have to continue to give eighty-grain doses of calomel every
two or four hours for a day or longer before you see any change
for the better. The case of the young white man at the farm
number three was one of these.

I suppose at sometimes'! may have given one hundred grains
of calomel at a dose, as I did not always weigh it. I never had
any reason to regret giving a large dose; but I have often, when
it was too late, had to blame myself for giving too small a dose.

Never, except in one instance, did I give over a hundred
grains at a dose. I will detail this case.

She was a negro woman *about forty years of age. I was called
to see her at 5 o'clock p. m. She was in collapse, and had been
abandoned by the physician in attendance. There was no one
with her but her daughter, a child some ten years of age. I
gave her eighty grains of calomel. I returned again at 9 o'clock
and gave her eighty grains more. I went back at 12 o'clock
(midnight), and gave her another eighty -grain dose. Having
now a little leisure, I remained with her until 3 o'clock A. M., and
used repeated astringent injections, as the rice-water discharges

Treatment of Cholera, 375

were still copious. Not being able to remain any longer, I
spoke very decidedly, and told her I would give her a dose
which would cure her, and gave her an ounce of calomel. When
I returned, between 9 and 10 o'clock the following day, she
smiled and said, "Well, doctor, that dose did cure me, for I
have not had another operation since I took it." The calomel
had to be worked off with castor oil. This wom^n was salivated,
but she speedily recovered.

I know that I treated over three hundred cases during this
epidemic, and hers was the only case in which the salivation was
the least troublesome. I was attending on a white woman at
the same time who had a uterine trouble, to whom I gave three
grains of blue-mass. It was difficult to tell which of the two
cases had the sorest mouth. I have no sort of doubt that the
ounce of calomel saved this woman's life. I can not tell why I
never tried so large a dose the second time ; but I would ask,
had not so large a quantity better be given when it was found
that eighty or a hundred grains were not sufficient?

I have no more doubt that calomel excites the liver to action
than I have that a piece of pickle will excite the salivary glands
and make the mouth water; but with some persons the bare sight
of the pickle will cause the saliva to flow, while others have to
take a good-sized piece into their mouth.

The gospel of Jesus Christ was to the Jews a stumbling-block,
and to the Greeks foolishness. The scientific medical men of the
world who agree with Dr. Hughes Bennett, and who believe that
the kidneys remove effete matter from the blood, will consider ray
teachings as foolishness ; but I tell them that there is no other
way to understand cholera, both as to the nature of the disease
and the treatment, than as I explain it.

Were I to have cholera I would much sooner rely upon a
steam-doctor, or a homeopathist, than a physician who entertains
these so-called scientific notions.

The steam -doctor would vomit me, at any rate, and the
homeopathist would do nothing, either of which I would prefer
to hypodermic injections and other visionary experiments. Per-

376 Treatment of Cholera,

haps both the steam-doctor and homeopathist would give me a
plenty of cold water. Of this I will now speak.

As far back as 1833 cholera patients in this city were allowed
to drink ice-water freely. From a review of Dr. Carrie's work
by Dr. John Esten Cooke we learn that he had commenced the
use of cold water according to Currie as far back as 1804. In
this review Dr. Cooke speaks of an epidemic fever which pre-
vailed in Winchester, Virginia, in 1826, in which he used cold
water, both externally and internally, as directed in Dr. Currie's
book.

Dr. Cooke always allowed his fever patients to drink cold
water freely; and when the cholera appeared, in 1833, he al-
lowed his cholera patients to drink ice-water freely. I do not
say that he was the originator of this cold-water practice, but
hardly any physician, who was not familiar with Currie's Med-
ical Reports, would have recommended it.

There is another very common error concerning cold water
and calomel. Most people believe that if you take a few swal-
lows of cold water after you have taken a dose of calomel, large
or small, you are sure to be salivated. This is a mistake. I
have taken many a twenty-grain dose of calomel, and always
drank cold water whenever I wanted it, and never was salivated.
Never wanting to salivate any patient, and having some respect
for the popular prejudices, as every sensible man will have, I
ordinarily direct my patients, to whom I have given calomel, to
drink only a swallow or two of water at a time until after the
medicine has acted.

But this precaution is not necessary in cholera. Salivation
never occurs when the vital powers are so depressed as they are
in the cold stage of cholera. It is only liable to occur after
reaction is established. The physician has only to be attentive
and to see that the calomel is worked off.

I have before said, that large doses of calomel often arrest all
cathartic action in the bowels. In such cases you must give
castor oil, or some other vegetable cathartic.

I have always allowed cholera patients to drink ice-water

Treatment of Cholera, S77

freely. Good cistern water is decidedly to be preferred. I do
not object to good French brandy or good whisky being mixed
with the water; for while I do not know that it does any good
— it certainly does not stimulate or create warmth — I do not
believe that it does any harm. If the water is vomited up I do
not believe that the patient is hurt thereby. So large an amount
of serum is carried off in the rice-water discharges that the
craving thirst seems to me to be the expression of a physical
want^ which water can only satisfy. No doubt a large part of
the water drunk is absorbed.

Some have recommended putting salt into the water. Where
it is not offensive to the palate and stomach of the patient, it
would not be amiss to try it. Many rely upon injections in the
treatment of cholera.

Among the tentative remedies, I think cold-water injections
might be tried.

There is a way of giving an injection, or enema, by placing
a gallon or half gallon bucket, four or five feet above the pa-
tient, with an India-rubber tube attached to the bottom of the
bucket, while to the other end there is attached a glass or metal-
lic tube, which passes into the bowels. By this method half
a gallon or a gallon of cold water could be made to flow into the
rectum without annoying the patient. It would probably health-
fully remove the heat which is sometimes so annoying in the
lower bowels, and might contribute to their more healthy action.
But I never tried it in cholera cases.

I tried medicated injections in 1849, but never found that
they did any good. As I used cold water externally applied in
the case of the young man already twice referred to, I will now
report his case.

As already stated I bled in one case. This young man was
the only patient to whom I applied cold water externally. He
was a man somewhat stoutly built, was five feet nine or ten
inches high, and twenty or twenty-one years old. His complex-
ion was sallow (not jaundiced) and his face had a somewhfit
puffy appearance. His temperament would have been called

378 Treatment of Cholera.

lymphatic. He was rather slow in his movements, though at-
tentive to business. This was the young man before he had the
cholera.

He consulted me Monday morning, being then troubled with
diarrhea. I told him he was threatened with cholera, and ad-
vised him what to do. But his employer urged him not to take
the medicine, but to drink French brandy. This he did. Find-
ing himself worse, he went to his brother's, on the farm referred
to. I visited him at 4 o'clock p. M. Wednesday. I found him
in the cold stage, the pulse being hardly perceptible at the wrist.
The rice-water discharges were frequent, but not as large as I
had seen them in some other cases. He occasionally vomited,
but this, too, was not excessive. I gave him eighty grains of
calomel, and ordered it to be repeated every four hours. As he
wanted to drink brandy, I told his brother to give him brandy
and water whenever he asked for it. I visited this young man
every day, but could perceive no change in his symptoms. The
pulse continued to be barely perceptible at the wrist; his limbs
were icy cold, and he had a cold, clammy sweat all over his
body. He continued to take the eightyTgrain doses of calomel,
but at long intervals after the first day. On Sunday morning I
found him in the same condition. Up to this time there had not
been the slightest evidence of bile in the alvine discharges. He
had drunk over half a gallon of the best French brandy since
Wednesday afternoon, and he had taken two or three ounces of
calomel.

Sunday morning I told him and his friends that I would try
what they might suppose to be an experiment if they would
promise to perform their part. They faithfully did perform it.
I had an open-headed whisky-barrel filled with cold water just
from the pump. I had a large wood fire made. The young
man's shirt was taken off, and he was carefully carried from the
bed, in a horizontal position, and put on a sheet on the floor; I
then dashed bucketful after bucketful of cold water over his
back and limbs, and over the front of his chest, until I had
emptied the barrel. The greater part of the water was thrown

Treatment of Cholera, 379

over his back and limbs. His body and limbs were rubbed for
a few seconds with a wet sheet. He was then removed to a dry
sheet before the fire, and was there thoroughly and briskly rubbed
by stout men. In the meantime a feather bed had been well pre-
pared, and a blanket, heated before the fire, was placed upon it.
The young man, being well rubbed, was put on this warm blanket,
and another warm blanket was placed over him, with other bed-
clothes; all of which was tucked in well around him. His posi-
tion was horizontal, there being no pillow under his head. Reac-
tion now commenced immediately, and he continued to improve
without let or hindrance. Dark, viscid, gelatinous bile soon
began to pass off, but it soon became of a healthy color. He
took a few doses of castor oil, and some vegetable cathartic pills.
He had no consecutive fever. He is now a well-to-do farmer,
living near Woodford, Kentucky; and he has repeatedly said
that he has been a stouter man and enjoyed better health since
he had the cholera than he ever was before.

There was not the slightest evidence of salivation in this
man's case. I never before or afterward saw a case of cholera
which continued for half so long a time in the cold stage, whether
the patient lived or died. I suppose that the cold-water douche
had an electrical effect upon this man's body. The congestions
of the great veins, the torpid condition of the liver and kidneys,
and the excessively weakened action of the heart, had continued
up to this time, over four days; but almost immediately after he
was wrapped up in bed motion and warmth appeared in every
part of his body, and the secretory glands at once commenced to
perform their healthy functions.

Dr. Cnrrie says, "That some sailors at Constantinople, in the
frenzy of the plague, had thrown themselves into the sea, and, it
is said, that on being taken out, they have recovered.''

A gentleman told me that among the passengers on the steamer
from San Francisco to Panama, there was a severe fever case.
The weather being very hot, the man was brought on deck, after
sundown, to get some fresh air. In his delirium he jumped
overboard. A boat was let down as soon as possible to recover

380 Treatment of Cholera,

the man, who, fortunately, could swim. It was some time, how-
ever, before they found him and brought him back to the ship.
The man was then entirely rational, and recovered his health in
^ a remarkably short time. Now I suppose that in all of these
cases the cold water had an electrical effect upon the sufferers.

In my cholera case friction and hot blankets had to assist the
cold douche in producing full reaction. In the other cases the
temperature of their bodies was, no doubt, beyond the standard
of health. But I do not suppose that the action of the cold
water was in either case confined to an influence upon the nerves
of motion, or the sympathetic system of nerves. I rather think
that it was exerted upon the nerves, both of organic and animal
life, which have their terminal branches in the skin. In the
experiments with ice on cholera patients in St. Louis, I believe
the ice was rubbed all over their bodies. If I were to apply ice
to the spinal column in cholera cases, I would not put it into
India-rubber bags, as Dr. Chapman directs, but into cotton bags,
so that it might melt in almost actual contact with the skin. I
think the ice would thus exert a more direct influence. The
electrical current, as I conjecture, passing between the ice and
the nerves of the skin would cause an irritation which might be
felt in every part of the body, and by the heart itself, which
would at once be stimulated to renewed action. In this cold or
collapse stage of cholera I think it idle to talk about any thing
being done, through the capillary system of blood-vessels, until
after the congestion of the great veins had begun to be removed.
The external application of cold water or of ice certainly de-
mands more extensive trials in the treatment of cholera. But
a man must first understand what cholera is, and then he should
carefully study Currie's Medical Reports, as well as Dr. Chap-
man's Essays, before he undertakes it.

I said that I had treated over three hundred cases of cholera
in 1849. I mean cases in which there could have been no dis-
pute as to their diagnosis. I am satisfied that I treated largely
over that number; and I am also satisfied that I did not lose over
thirty cases which were entirely under my management. I saw

Treatment of. Cholera, 381

some cases in consultation which died, but I was not called to
see them until they were past recovery under any treatment. It
is more than probable that they would have died had I been the
first physician to see them. In all cholera epidemics there will
occur cases which are beyond recovery from the onset. They
may not be so suddenly mortal as at Muscat and Teheran, but
they are bound to die. But cases recovered in Lexington in 1833
and in 1849, and in the lunatic asylum near here in 1855, which
were apparently as hopeless as the cases which terminated fatally.
Indeed, many cases died which, as far as any body could tell up
to a very short time before death, were not half as bad as many
cases which recovered.

Dr. Mackintosh says that one of the most apparently hopeless
cases he ever treated recovered. Cholera, I think, is the most
manageable of all severe forms of disease. There are mild types
of measles, of scarlet fever, of typhoid fever, and even of small-
pox; but when we have the severe or malignant types of these
fevers, they are more difficult to manage than cholera. Inasmuch
as the mortality of cholera cases almost every where, and up to
the present time — for it is now prevailing in Brazil — is put down
at fifty per cent or higher, it can not be said that there is any mild
type of cholera. I know that in the case of cholera as an epi-
demic, as with other epidemics, the disease becomes milder, and
more manageable as it begins to disappear. But in Lexington,
in 1849, there were a few suddenly fatal cases after it was thought
that we would not have another.

Whatever you propose to do in cholera must be done quickly.
I know that large doses of calomel will not only arrest the rice-
water discharges, but that it will cause the liver to secrete bile
freely and pour it out into the duodenum, thus relieving the con-
gestion. Having thus stopped the pouring out of serum from
the blood, and having set up another action which separates the
eifete matter from the blood, it is then all fair sailing. You have
only to see to it that the liver continues to secrete bile and to pour
it out. Attending to this, you have only to give your patient
proper food, and with good nursing he will certainly get well.

382 Treatment of Cholera,

It is now very common with many physicians to give calomel
in combination with quinine. I see no objection to the practice
in cholera cases, but think it would be better to postpone the
quinine until after the liver has begun to pour out bile. As
to quinine, much will depend upon its being agreeable to the
stomach.

Up to the present time calomel is the only medicine which
can be relied upon to cure cholera. I have explained how it
does it. It is possible that some other medicine may be discov-
ered which will accomplish the same good result. But it is not
possible that cholera can be cured in any other manner than as I
have explained. The congestion, which is the most marked of
all the elements of cholera, must be removed. This can not be
effected without causing the liver to act vigorously in the per-
formance of its proper functions.

That the liver may be made to act by other indirect methods,
I have already admitted. These indirect methods, then, consti-
tute the field of discovery. It is one which demands the most
careful exploration; for the prejudice against calomel is so strong
and so deeply rooted in the minds of the people, that it is not
probable that calomel will be given a fair trial in the treatment
of cholera for a long time to come. It will not have this trial
until many other microscopic and chemical theories have proved
themselves to be worthless ; not until the people prefer taking a
dram, or more, of calomel to dying.

Appendix, 383

APPENDIX

The Use of Cold Water in the Treatment of Fevers.

[From St. Louis Medical and Surgical Journal, July, 1878.]

The history of medicine presents no fact so singular as that
of the use of water in the cure of diseases. Dr. Currie says
that its uses as a remedial agent had been so entirely forgotten
that he claims his method of using it to be a discovery.

He took particular pains to introduce his book to the medical
profession. He sent copies of the first edition, published in
1797, to the medical schools in Ireland, Scotland, and England,
and gave copies to many surgeons of the British army and navy.
These gentlemen, together, visited all parts of the habitable
globe. The practice was a success wherever tried, whether in
the north of Scotland or w^ithin the tropics, and yet Currie's
method was again soon forgotten.

I have been practicing medicine over forty-three years, and
my attention, and that of a large medical class, was called to Dr.
Currie's book in an introductory lecture delivered by Dr. John
E. Cooke, at Lexington, Ky., November, 1835. Dr. Cooke had
adopted Currie's method in 1804, at Winchester, Va., and yet I
have not met with half a dozen physicians who ever saw a copy
of Dr. Currie's book; and until within the last few years as
many more who knew any thing at all about his method of
using cold water. The practice came back by accident when
Priesnitz introduced his hydropathic system. I will give one
of the accidental cases as an illustration. I could give sev-
eral score of them.

A distinguished lawyer told me that he had a severe attack
of miasmatic fever while stopping at the residence of a friend

384 Appendix.

near Natchez, Mississippi. Two or three of the best physicians
of that city were attending on him. After he had been ill ten
days or two weeks, I forget which, he overheard them say in an
adjoining room that he could not live over twenty-four hours.

They had not allowed him a drop of cold water to drink, nor
had it been applied to his body in any manner. That night his
nurse went to sleep. He got out of bed the best he could, and
crawled to a large spring in the yard. He drank a very large
quantity of water, and then got into the spring and remained
there until he felt comfortable. He then crawled back to bed
and immediately went to sleep. The next morning he was con-
valescent.

I will give one other case where cold water was drunk. A
gentleman told me that he was called to sit up with a young man
in Garrard County, Kentucky, who was very low with fever.
He sat up with the patient till two o'clock, A. M. As soon as
every body else had left the room, the patient asked his nurse
to go to the spring and bring a pail of fresh water. At two
o'clock, when t^e other nurse was called, the first one said to the
second, "If he wants any more water, there is a fresh pail of it
in the porch." The reply was, " You have not given him cold
water! His physician positively forbid it." The answer was,
" I did not know that ; he has drunk over a gallon." The next
morning this patient was convalescent.

I could give a hundred cases where cold water was only drunk
in this secret manner, which were told to me either by the indi-
viduals who had been cured by drinking cold water or who had
been witnesses to the fact. I will make the application of these
facts before I conclude. Dr. Currie's method is now referred to
by many of the first physicians, both in Europe and the United
States, but his method is not followed. I will now give it, and
then the methods now practiced in Europe.

I copy from a reprint of the fourth London edition of his
work, published at Philadelphia in 1808 (see page 27, etc.) :

" The manner in which the Affusion of Cold Water ought to he
used in Fever. — It will be proper to premise that when the term
fever is used in the present work without an adjunctive it is the
low, contagious fever that is meant. This is the typhus of Dr.
Cullen, the contagious fever of Dr. Lind, the febria inirritativa

Appendix. 385

of Dr. Darwin. In popular language it is generally called the
nervous fever, and, where particular symptoms appear, the putrid
fever. This is the common fever in England. Who ever has
watched the progress of fever must have observed the justness
of the observation made by Cullen, Vogel, De Haen, and others,
that even those genera which are denominated continued are not
strictly such, but have pretty regular and distinct exacerbations
and remissions in each diurnal period. In this space of time Dr.
Cullen contends that an attentive observer may commonly dis-
tinguish two separate paroxysms. My observations do not enable
me to confirm his position in its fullest extent, but one exacerba-
tion and one remission in the twenty-four hours seem generally
observable. The exacerbation usually occurs in the afternoon or
evening, the remission toward morning.

" If the heat of the patient be at such times taken by the ther-
mometer it will be found to have risen one or two degrees in the
central parts of the body above the average heat of the fever,
and still more on the extremities. The safest and most advan-
tageous time for using the aspersion or affusion of cold water is
when the exacerbation is at its height or immediately after its
declination has begun; and this has led me almost always to
direct it to be employed from six to nine in the evening, but it
may be safely used at any time of the day when there is no sense
of chilliness pi^esent, when the heat of the snrface is steadily above
what is natural, and when there is no general or profuse sen-
sible perspiration. These particulars are of the utmost impor-
tance.

"First. If the affusion of cold water on the surface of the
body be used during the cold stage of the paroxysm of fever,
the respiration is nearly suspended; the pulse becomes fluttering,
feeble, and of an incalculable frequency ; the surface and extremi-
ties become doubly cold and shriveled, and the patient seems to
struggle with the pangs of instant dissolution.

" I have no doubt from what I have observed that in such cir-
cumstances the repeated affusion of a few buckets of cold water
would extinguish life. This remedy should therefore never be
used when any considerable sense of chilliness is present, even
though the thermometer applied to the trunk of the body should
indicate a degree of heat greater than usual.

25

386 Appendix*

" Second. Neither ought it to be used when the heat, measured
by the thermometer, is less than, or even equal to, the natural
heat, though the patient should feel n^ degree of chilliness.

*^ Third. It is also necessary to abstain from the use of this
remedy when the body is under profuse, sensible perspiration,
and this caution is more important in proportion to the continu-
ance of this perspiration. Sweating is always a cooling process
in itself, but in bed it is often prolonged by artificial means; the
body is prevented from cooling under it to the natural degree
by the load of heated clothes. When the heat has been thus
artificially kept up a practitioner, judging by the information of
his thermometer only, may be led into error.

" Under these restrictions the cold affusion may be used at any
period of the fever; but its effects will be more salutary in pro-
portion as it is used more early. When employed in the advance
stages of fever some cordial should be given immediately after
it, and the best is warm wine.

"Case I. — A nurse in the fever ward of the Infirmary was
seized with violent rigors, chilliness, and wandering pains suc-
ceeded by great heat, thirst, and headache. Sixteen hours after
the first attack her heat at the axilla was 103° F., her pulse 112
in the minute, and strong; her thirst great, her tongue furred,
and her skin dry.

" Five gallons of salt water, of the temperature of 44° were
poured over her naked body at five o'clock in the afternoon;
and, after being hastily dried with towels, she was replaced in
bed. When the agitation and sobbing had subsided her pulse
was found to beat at the rate of ninety-six strokes in the min-
ute, and in half an hour afterward it had fallen to eighty. The
heat was reduced to 98° by the affusion, and half an hour after-
ward it remained stationary. The sense of heat and headache
were gone, and thirst nearly gone. Six hours afterward she was
found perfectly free from fever, but a good deal of debility re-
mained. For several days the cold affusion was repeated at the
same hour of the day as at first ; the fever never returned. The
bath was repeated, in the second case, four times; in the third
case, six times; in the fourth case, four times; in the fifth case,
three times; in the sixth case, three times; in the seventh case
nine times."

Appendix, 387

Dr. Ciirrie gives an account of the fever that prevailed in the
Thirtieth Regiment at Liverpool in 1792 : " It extended to fifty-
eight persons, in all of which thirty-two went through the regu-
lar course of the fever, and in twenty-six the disease seemed to
be cut short by the cold affusion ; of thirty-two, already men-
tioned, two died. These two cases were men so debilitated by
previous infirmities that it was not thought advisable to use the
cold affusion at all. In some of the cases reported the cold
affusion was not used until the ninth day of the fever. In a
majority of the cases it was applied only o«ice in the twenty-
four hours. It was not used oftener than twice a day in any
case. It was always applied at the exacerbation of the fever.

" The cold affusion may also be employed with success in inter-
mittent fevers, as I have found by repeated trials. Though the pa-
tients were often startled at the first proposal of dashing the cold
water over them, yet, after one trial, there was seldom any diffi-
culty in persuading them to have it repeated. The effects were,
in general, highly grateful and refreshing to their sensations.

"The extinction or abatement of fever was commonly fol-
lowed by more or less diaphoresis, and this again by refreshing
sleep. At first, I used fresh water; afterward fresh water mixed
with vinegar ; and lastly, a saturated solution of sea-salt in water.
In the instance of the Thirtieth Regiment I used the water of
the river, which contains about a thirty-third part of salt, as has
been already mentioned, and this I commonly employ in private
practice. I was led to prefer salt-water to fresh on account of
the stimulating effect of sea-salt on the vessels of the skin, by
which I apprehend the debilitating action of cold is prevented.
Salt-water, either for the purpose of immersion or affusion, is
more grateful to the patient than fresh water, and it is well
known that it may be applied to the surface for a length of time
with much less hazard. Persons immersed in sea-water, and es-
pecially in saturated brine, for some time together, preserve the
luster of the eye and the ruddiness of the cheek longer than
those in fresh water, of an equal temperature, and such persons
exhibit the vital reaction stronger when removed from it."

The heat was always tested by the thermometer placed under
the tongue or in the axilla, and the cold affusion was never ap-
plied unless the heat was above the standard of health, and not

388 Appendix.

in a single case reported unless the temperature was 101° F. or
higher. The affusion was made by dashing bucketsful of cold
salt-water over the patient in quick succession ; and the patient
was quickly rubbed dry and put in bed.

^'Drinking Cold Water. — The effects of cold water as a drink
in fevers I was naturally led to examine by my experience of its
effects as an external application. I have made this examination
with the thermometer in my hand, and with all the attention in
my power; and the following results, which will save the reader
the fatigue of reading the particulars of various cases and experi-
ments, seem to me to contain all the information necessary to
direct our practice. Cold* water is not to be used as a drink in
the cold stage of the paroxysm of fever, however urgent the
thirst. If the thirst is gratified in the cold stage of the parox-
ysm, it ought to be with warm liquids. When the hot stage is
fairly formed and the surface is dry and burning, cold water may
be drunk with the utmost freedom. Frequent draughts of cold
liquids at this period are highly grateful. They generally dimin-r
ish the heat of the surface several degrees, and they lessen the
frequency of the pulse. When they are attended with these sal-
utary effects, sensible perspiration and sleep commonly follow.

" Throughout the hot stage of the paroxysm cold water may
be safely drunk, and more freely in proportion as the heat is
further advanced above the natural standard. It may even be
drunk in the beginning of the sweating stage, though more
sparingly. Its cautious use at this time will promote the flow
of sensible perspiration, which, after it has commenced, seems
often to be retarded by a fresh increase of animal heat. A
draught of water taken under such circumstances will often
reduce the heat to the standard at which perspiration flows more
freely, and thus bring the paroxysm to a speedier issue.

"Among the ancients the internal use of cold water in ardent
fevers is recommended by Hippocrates, Galen, Celsus, and most
of the celebrated physicians whose works have come down to us."
Among the modern, that extraordinary man, Cardanus, wrote a
dissertation in its favor, and to pass over a multitude of inferior
names, Hoffman, though with some restrictions, recommends it
not in fevers only, but in various other diseases. In our own
country it was proposed as an almost universal remedy by Smith,

Appendix. 389

and a treatise has been written on it under the title of Febrifugum
Magnum by Dr. Hancock.

In Spain and Italy the use of cold water in fevers obtained,
in the beginning of this century, a greater and more general rep-
utation than in any other countries in Europe, and at one time
seems to have superseded all other diet, as well as medicine.
This treatment was celebrated under title of Diceta Aquce.

This practice was opposed by the celebrated Boerhaave. And
yet Dr. Edward H. Clark, in his Century of American Medicine,
begins his article in the words which immediately follow : " When
Boerhaave, the most accomplished and celebrated physician of
the eighteenth century, died, he left behind him an elegant vol-
ume, the title-page of which declared that it contained all the
secrets of medicine. On opening the volume every page, except
one, was blank. On that page was written, ^ Keep the head cool,
the feet warm, and the bowels open.^ This legacy of Boerhaave
to suffering humanity typified not inaptly or unjustly the acquire-
ments, not of medical science, but of medical art, at the close of
the eighteenth century.''

In this article of Dr. Clark's, twenty-two pages are devoted
by Dr. Bigelow to the discussion of the question as to whether
Drs. Morton, Wells, or Jackson discovered modern anesthesia.
While I admit the inestimable value of chloroform and ether in
the practice of surgery and obstetrics, it must be admitted by
every one who will allow himself to think, that one thousand, if
not ten thousand, patients are comforted by a free drink of cold
water to one single case where the use of chloroform or ether is
admissible. The same is true to a less extent as to the applica-
tion of cold water to the bodies of fever patients, according to
Currie's method.

But when a Boston physician, writing in 1876, was ignorant
that such a school as the Medical Department of Transylvania
University ever existed, or that there was ever a medical school
west of the Alleghany Mountains, it is not to be wondered at that
he never knew that such a man as James Currie ever lived.

Thomas Jefferson said that he had lived long enough to out-
live three different medical theories. I say that the human family
will not live long enough to outlive the doctrines of Currie and
his predecessors, when correctly and fully understood.

390 Appendix.

I will now briefly refer to the other methods. In his article
on Typhoid Fever, Niemeyer says, ^*As often as the temperature
rises above 104° the patient is placed in a bath whose tempera-
ture is about 10° below that of his body, or about 94°. While
the body and limbs are gently rubbed we add cold water gradu-
ally till the temperature of the bath is reduced to about 68°. The
patient is to remain about twenty or thirty minutes in the bath,
till he; is slightly chilled, and then to be placed quickly in a warm
bed. At first four or five baths are necessary ; subsequently two
or three a day."

Dr. Brandos Method, as practiced at Stettin. — Dr. Brand en-
deavors to maintain the temperature of the body below fever
heat at the beginning of the disease. At the first, or beginning
of the second week, the patient is to be placed up to his neck in
a bath at the temperature of 68° F., and at once cold water — 43°
to 47° F. — is poured over his head ; an important point, especially
when cerebral symptoms are present. The following days, when
doubtless the nervous system will be excited, water at the tem-
perature of the bath will serve for the douche. The douche
should be continued during a couple of minutes. The assistant
will afterward rub and shampoo under the water the limbs of
the patient during some three or four minutes; the patient is
then to be left quiet. By that time a transformation can already
be observed in him. He was, perhaps, unconscious when placed
in the bath ; he now begins to complain ; the tongue gets moist,
the face assumes a more natural appearance, and the previous
drowsy, stupid look gives way to an expression of astonishment
and fear. After the patient has been some eight minutes in the
bath he is seized with a violent rigor ; the teeth chatter, he pants
for breath, and a violent and repeated fit of coughing is followed
by the expectoration of thick bronchial mucus. Frequently
there is an involuntary stool. The patient by this time feels
anxious, and endeavors to get out of the bath, but the physician
must here more than remember Dr. Brand's aphorism: ^'The
patient will shiver and chatter his teeth, but he must remain
fifteen minutes in the bath.'' If the rigor appears early, the
bath should last only fifteen minutes, and somewhat longer
should the shivering appear later. Before removing the patient
from the bath the head-douche should be repeated. Taken out

Appendix. 391

of the bath, the patient can be supported by the assistant; he
trembles with cold, his skin marbled, shaking like a leaf beaten
by a strong wind. He is at once carried to his bed, and his shirt
should be put on without previously wiping him ; a single sheet
should be thrown over in summer, or a light blanket in winter.
Next, a cupful of tepid broth should be given to him, followed
by a mouthful of good old wine ; he is then to be left perfectly
quiet. The shivering will last from twenty minutes to nearly an
hour. The cold baths are repeated every third hour, day and
night, until the temperature in the rectum measures only 101° F.
Dr. Brand applies his method to all cases and during all the
stages of the disease. Such is Dr. Brand's method.

Dr. Glenard's opinion is the following : " You will not find
in the five or six thousand cases of typhoid fever treated by this
method one single unsuccess among those which have been sub-
mitted to it since the beginning of the disease. To insure success
Brand's method should be rigorously applied from the beginning
of the disease ; sometimes the treatment will require from fifty to
two hundred cold baths. The duration of the disease is not less-
ened by this treatment ; convalescence does not begin before the
twenty-first day ; it is, however, shorter and easier.'*,

Liebermeister^s Method. — " The appearance of Jiirgensen's
work, in which the results achieved at Kiel were set forth in an
impartial and strictly scientific manner, marked an epoch in the
treatment of typhoid fever. It appeared from this work that if
the energetical withdrawal of heat from the body, was to be fol-
lowed by any marked result, it must be repeated as often as the
temperature of the body rose above a certain point."

"E. Brand, in Stettin, was about the only man who used
cold-water treatment in the proper degree of system and
vigor."

Liebermeister's method does not difier materially from that
of E. Brand. He says, "As a rule in somewhat severe cases I
have the temperature taken every two hours, day and night.
Whenever the temperature in the rectum reaches 103°, or in the
axilla 102.2°, a cold bath is given."

The success in the treatment of typhoid fever cases, recorded
by these German physicians, is extraordinary. Dr. Cullen said

392 Appendix.

that medical facts were medical lies. I will not be so unchar-
itable; but from my observation of typhoid fever cases, and
from what I know of the lesions that occur in the intestines in
these cases, I can not understand how the patients could stand
so severe a shock, and that continually repeated.

The practice above detailed is not at all according to Currie.
I have never used the aspersion of cold water or the putting the
patient into a cold bath, except in the exacerbations of fevers,
whether they be miasmatic or typhoid. Dr. Currie says that the
theory of Boerhaave, of lentor of the blood, put a stop to the
use of cold water, whether as a drink or externally applied,
throughout Europe ; and that the cold-water treatment of fevers
had been almost entirely forgotten, when he again introduced its
use and wrote about it.

Tens of thousands of individuals have died in torture for the
want of cold water as a drink, and as an external application,
because of Boerhaave's theory. It is greatly to be feared, I
think, that the use of cold water, as detailed above, by German
and other European physicians, will again bring the practice
into disuse.

I would urge upon all physicians to confine themselves to
Currie's method. It appears that the duration of typhoid fever
is not shortened by the external application of cold water as now
practiced in Europe. If Dr. Currie is to be believed, the dura-
tion of the fever in his cases was cut short in a remarkable man-
ner. Where calomel is given in the early stages of typhoid
fever, as I have explained in a former chapter, and where cold
water is given to drink and externally applied, strictly in ac-
cordance with Currie's method, as I have always done, I know
that they are cut short, and that convalescence ordinarily begins
on twelfth or thirteenth day.

The external application of cold water dose not remove the
cause of the high temperature in these fever cases. That cause
is the fever poison and the presence of a large amount of effete
matter in the blood. How that is to be removed I have already
explained. Dr. Currie gave calomel to his fever patients.

Appendix. 393

. APPENDIX n.

Can Fevers be Cut Short by Currie's Method, or by any other?

When Lady Mary Wortley Montagu introduced into Eng-
land from Constantinople the method there practiced to prevent
the severity and mortality of smallpox, she conferred upon West-
ern Europe a boon second only in value to the discovery of the
immortal Jenner. And that was not all. This Asiatic contri-
bution to the medical art of Europe demonstrated that the most
malignant, the most disgusting and fatal of all fevers can be cut
short; indeed can be made so mild as hardly to disturb the ordi-
nary, healthy functions of the human economy.

This was done not by the use of a specific or an antidote, so
called, but by the preparation of the individual to be inoculated
with smallpox matter. The method of doing this was by dieting
or the administration of some simple medicine. In other words,
the physician saw that his subject was in a healthy condition.
The testimony of medical men is almost unanimous as to the
entire success of this method, and the very, very small percent-
age of deaths.

Indeed there are not a few physicians still living who prefer
inoculation to vaccination. This is because vaccination is too
often carelessly and imperfectly performed. It is well known
that an individual may have caught smallpox and gone a week
or ten days before vaccination, and yet the latter will arrest or
so change the smallpox poison as to make the case a very mild
one and cut it short.

The great Abernethy pursued a similar method in his surgical
practice. He prepared his subjects before operating on them.
The no less distinguished Benjamin W. Dudley, of Lexington,
Ky., prepared his subjects always, before using the knife, by diet-
ing and giving such medicines as he thought necessary. Aber-

394 Appendix.

nethy iu England and Dudley in the United States established
the method of the constitutional treatment of surgical diseases.
Nowadays the reverse is too much the case, and many constitu-
tional troubles are treated by surgical appliances. This is all
because of the received physiological doctrines of the day.

The fever treated by Dr. Currie was, he said, the common
fever of England, described by authors variously according to
their theories. It is not to be supposed that there has been any
change as to the essentials of fever in England since the days of
Currie.

Andral, Chomel, and Louis were among the first to point out
the particular lesions which distinguish typhoid fever, for in-
stance, from other fevers. The fevers now recognized in Eng-
land and on the Continent of Europe are typhus, typhoid, and
relapsing fevers.

Of the causes of these fevers Dr. Alfred Hudson, of Dublin,
in his lectures on the study of fever, thus speaks: "Typhus fever
originates from a contagium vivum generated in the human body.
It is communicable from one individual to another by infection ;
that is to say, a healthy man may contract typhus fever by going
into the sick-room.^'

Dr. Hudson thinks that typhus fever may be generated de
novo in overcrowded and ill-ventilated apartments. Typhoid
fever can not, according to him, be caught by attending on a
fever patient simply. It is generated from the fecal dejections,
which must undergo decomposition and be introduced, somehow
or other, into the water which we drink.

Liebermeister, in his article on Typhoid Fever, in Ziemssen's
Cyclopedia, says, " We are therefore forced to the conclusion that,
besides external conditions favorable to the development of the
typhoid poison, something else is necessary. Numerous facts
render it more than probable that this something necessary is
the specific poison itself. In other words, the poison of typhoid
fever does not originate in decomposing substances, but finds in
them a favorable ground for its growth and multiplication. The
most convincing experiences show that typhoid fever never origi-
nates in any unusual amount of decomposing matter, nor from
any circumstance favorable to decomposition, but is always pre-
ceded by the introduction of a case of the same disease."

Appendix. 395

Relapsing fever, according to Hudson, is developed from the
decomposition of animal and vegetable matter found in sewers
and elsewhere, with which sources of origin he associates the
exposed banks of rivers.

Authors are by no means accurate or clear as to the specific
origin of relapsing fever. These fevers all differ in many par-
ticulars as to their onset and course and the organs within the
body particularly affected.

If Dr. Currie saw cases of each of these three forms of fever,
as we must suppose he did, he does not distinguish or separate
them. He claims for his practice a success which is not now
accorded to it; indeed Dr. Hudson, in his comparatively recent
work, says that Curriers practice has gone into disuse; at the
same time he attributes very great virtue to the copious drinking
of cold water in certain stages of fever.

It would appear from medical journals that the use of cold
water in the treatment of fevers is to-day more practiced in Ger-
many and perhaps some of the hospitals in Paris than any where
else. It is to be feared, however, that the practice, as there
carried out, will not become general. No form or method of
medical practice which is practical only in hospitals can ever be
of much real value to the human family. We will state this
modern practice according to the most recent and highest au-
thorities, E. Brand and Liebermeister.

According to them, an adult fever patient with a temperature
of 102° F. in the axilla is to be placed in a full-length bath-
tub, the temperature of the water being 68°. He is kept in the
tub for ten minutes, and then wdped dry and put to bed. In
feeble cases the method of Ziemssen is preferred. The tempera-
ture of the water is 95° F., which is to be gradually reduced by
pouring in cold water.

Liebermeister says, "Above all things, it is important for the
physician to free himself from the delusion that any thing essen-
tial can be accomplished by one or by a few baths. In very
severe cases it is necessary to repeat the bath every two hours, so
that twelve baths are given every twenty-four hours. In some
instances that have occurred in the hospital at Basle, the number
of baths required by a patient during his entire illness has
exceeded two hundred. These were especially obstinate attacks,

396 Appendix.

in which the intense fever would undoubtedly have caused death
had any less energetic treatment been adopted."

" In the majority of cases, especially if antiphlogistic drugs are
administered at the same time, four to eight baths per diem will
be found sufficient, with forty to sixty in the aggregate. I
would particularly insist upon the urgent necessity of continu-
ing the baths during the night as well as by day in severe cases
as often as the recurring high temperature demands."

'^Cold affusions have much less effect, according to direct
calorimetric observations, than baths of the same temperature
and duration, but they are much pleasanter to the patient. They
are, therefore, only to be recommended when the circumstances
are such as to forbid the use of any more efficient method of
abstracting heat; or when one desires not so much to lower the
temperature as to produce a brisk, stimulating effect on the phys-
ical functions or the respiration."

It seems that Liebermeister does not push the practice as
did E. Brand at Stettin, where the patients' teeth chattered and
they shivered from cold. The success claimed from this practice
was at most complete, and yet the fever cases (typhoid) were not
cut short, but continued their usual course of twenty-one days.
Convalescence was more rapid, though many of the patients had
a crop of boils.

We say that this method of using cold water in fever cases is
not practicable in private practice. From a careful examination
of Dr. Curriers book we can not find that he used the cold water
affusion in any case over nine or ten times. Dr. Currie had no
theory to be sustained or explained by his practice.

High temperature is now said to be the cause of death in
fevers ; and it is to reduce this temperature, and keep it reduced
during the entire course of the fever, that this modern German
practice is founded.

J. Burdon Sanderson, M. D., etc., etc., has published in the
London Practitioner, for 1876, three highly interesting and in-
structive papers on The Process of Fever, in which temperature
is fully considered. He says, " The recognized characteristics of
fever are those which relate either to the disintegration of the
living substance of the body, or to the increased or diminished
constancy of the bodily temperature."

Appendix. 397

^'Textural Disintegration in Fever. — Even to the superficial
observer it is obvious that in fever the body wastes. But it is
only by the scientific methods of measurements and comparison
that we know how this waste takes place — how in fevered per-
sons or animals the living substance of the body is disintegrated.
This central attribute or characteristic (as it appears to be) of
fevers, is known partly from the study of fever artificially in-
duced in the lower animals, partly by observation of clinical
cases. From the former source we obtain facts which are more
definite, and therefore better fitted to serve as foundations for
our knowledge.

"But the indications afforded by clinical observations, even
though they may be less precise, are often of greater value, be-
cause they bring us nearer to the purpose of all pathological
inquiry — the learning of the nature and cause of human ail-
ments.

"Both in the clinical and in the experimental investigation
of diseased processes, measurement without comparison is useless.

"Thus, in health, the discharge of nitrogen in the excreta is
exactly counterbalanced by its introduction in^od, so that it is
only when this is the case that the person or animal can be said
to be in a normal state of nutrition, whether the actual quantity
of nitrogen which passes through the body in a given time is
large or small.''

"If, in any disordered condition of health which is under
investigation, it is found that the quantity of nitrogen discharged
is absolutely smaller or larger (as the case may be) than in the
same individual when well, we can conclude nothing from this
unless it is ascertained at the same time how much nitrogen
enters, in order that by balancing the one quantity against the
other, we may learn whether the amount which is stored in the
bodv is being wasted on the one hand or accumulated on the
other. Or, to use the ordinary and perfectly convenient lan-
guage of physiology, we judge whether integration or disinte-
gration of living substance is going on, not by the absolute
income or expenditure, but by the nitrogen exchange — by the
excess or defect of nitrogen expenditure as compared with
nitrogen income."

"In health, the whole of the nitrogen discharge is derived

398 Appendix.

from food. In inanition, when nitrogen income vanishes, all the
nitrogen which passes out as urea or otherwise is derived from
stored or tissue albumen.''

I frilly concur with these views of Dr. Sanderson, except that
I would conclude the last sentence by saying " is derived from
effete matter."

" The general conclusion to be derived frorri the whole series
is, that in the early stage of fever a patient excretes about three
times as much urea as he would do on the same diet if he were
in health; the difference between the fevered and the healthy
body consisting chiefly in this, that whereas the former dis-
charges a quantity of nitrogen equal to that taken in, the latter
wastes the store of nitrogen contained in its own juices."

" Heat stands on the same line with carbonic acid, urea, and
water, as a product of chemical work done in the human body."

"To determine whether or not its production is increased or
diminished, we have to proceed by continuous measurement."

" The general result, to which the preceding calculation leads
us, is a very imnortant one, namely, that although, as compared
with the heat-production of a fevered person is excessive, it is
not by any means greater than the heat-production of health;
for the highest difference indicated by the numbers stated is
insignificant."

" In the first stage of fever the discharge of heat is rather
diminished than increased, so that at this period it is probable
that there is an abnormal retention. As the febrile process pro-
gresses, and when it is at its highest, fluctuations exhibit them-
selves in the quantity of heat liberated, which resemble those
which are observed in the discharge of carbonic acid and of
aqueous vapor; but it can not as yet be determined whether the
amount of heat given off during the whole course of the febrile
process is greater or less than the quantity of heat given off
during the same period of asphyxia. In judging of the signifi-
cance of the fact just stated, it must be borne in mind that the
normal with which the febrile thermogenesis is here compared is
that of inanition."

Dr. Leyden expresses his conclusions as follows: "The dis-
charge of heat is increased in fever, whether the temperature is
constant, falls, or rises. Consequently it is certain that the pro-

Appendix, 399

duction of heat is increased. In high fever the quantity of heat
given off is from half as much again as the normal to twice as
much. The most rapid discharge of heat takes place in the crit-
ical stage, when the temperature is rapidly sinking. It may then
be twice, or even three times as great as the normal. Defisrves-
cence is associated with marked sweating and evaporation at the
surface; fervescence, by the absence of these phenomena, even
where the coverings are airtight.

" The question we have before us is not, whether the fact that
in febrile pyrexia the temperature is, as a rule, increased both in
man and animals by two or three degrees, is due to this or that
cause, but simply whether in fever, along with increased temper-
ature, there is also increased production. That ceteris par^ihus
there is in fever an increased activity of certoAn processes which
produces heat, can be proved without calorimetrical measure-
ment.

"Supposing the state of the heat-discharging surfaces to re-
main the same, the fever patient must necessarily produce more
heat to keep his body up to the higher work as regards tempera-
ture than the healthy person. In other words, supposing the
quantity and quality of clothing, and the temperature and moist-
ure of the air to remain the same, and the discharge of watery
liquid from the sweat-glands to be also the same, the fevered
person would give off a somewhat larger quantity of heat from
the surface than a healthy person; for the difference between the
temperature of his body and that of the environment being
greater, the loss by radiation and convection would be propor-
tionally greater. The difference, however, would certainly be
small, greater somewhat in summer than in winter, and greater
in bed than in clothing.

" It is also certain that the process of disintegration of tissue,
of which the evidence has already been presented to us, is in its
nature thermogenetic. In the preceding section I have estimated
that increase, and have shown that there is unquestionably a
very considerable difference between the h6at-production of a
febrile and of a non-febrile person on the same febrile diet. I
have also pointed out that this holds true only as long as the
comparison is made under similar conditions of nutrition, for if
we compare the heat-production of a fevered patient with that of

400 Appendix.

a person in health on ordinary diet, we find that whatever differ-
ence presents itself is quite within the limits of normal variation.

^'The fact of the greater consumption of material in fever
may therefore be dismissed entirely from our minds in entering
on the consideration of observations similar to those of Professor
Leyden.

"The temperature of the healthy human body has been re-
cently determined by Jiirgensen on a larger basis of accurate
measurement than before existed. The mean tempej*ature of a
day and night of a healthy person, as measured in the rectum, is
37.2° C. (98.9° F.) If the whole period of twenty-four hours is
divided into two, of which one, commencing at the moment that
the bodily temperature reaches its morning maximum, ends with
the attainment of the evening maximum, the other corresponding
to the interval, it is found that in the diurnal period, viz. between
7 or 8 A. M. and 9 p. m., the mean temperature is 37.34°, while in
the nocturnal period, of which the duration is shorter in the pro-
portion 100 to 136, the mean temperature is 36.94° C. (98.5° F.)

"In relation to our present inquiry, Jiirgensen's researches
have led to a most remarkable result, which was entirely unex-
pected, viz. that the mean temperature of the human body is
remarkably independent of the conditions which temporarily
affect the production of heat, even when their influence is most
powerful. Thus, by observations on a vigorous and healthy
person, who voluntarily submitted to inanition for sixty-three
hours, it was found not only that the mean temperature of the
two days was exactly the same as in ordinary conditions of nu-
trition, but that the diurnal temperature curve was not modified
in its character. Again, it was ascertained by most accurate
observations on the same patient, who submitted to a succession
of cold baths, each lasting twenty-five minutes, at temperatures
varying from 9° to 11° C. (50° F.) that notwithstanding the rapid
abstraction of heat which gave rise to a shivering lasting for
several hours, the diminution of bodily temperature which oc-
curred during the bath was followed, after an interval of four or
five hours, by an elevation which precisely compensated it, so
that if the average was taken of observations extending over
sufficiently long period the mean was the same as under normal
conditions."

Appendix. 401

" The extensions of Jiirgensen's observations to fever led him
to the remarkable discovery that in continued fever, and particu-
larly in typhoid, the diurnal variation of bodily temperature
closely resembles that of health." ....

" Clinical observation has established the fact (whatever may
be its therapeutical value) that in typhoid and other fevers, the
temperature can be brought down, and kept down, nearlv to the
normal by the systematic use of cold bath or of cold affusion."

A candid consideration of all that I have quoted from Dr.
Sanderson ought, I think, to convince any one that while the
temperature in fevers may be kept down by a frequent repetition
of cold baths, yet that the practice as carried out by E. Brand,
particularly, is neither necessary nor advisable. It has been
seen that the temperature rises after every bath, let them be
repeated a dozen or more times a day, so as to keep up a diurnal
equilibrium, as is the normal rule in health, ai^ even in fever
cases, where no cold baths are given.

When a bath is given twelve times a day, the temperature is
made to fall and then to rise twenty-four times. Can such inter-
ruption of natural processes be advisable? It will be seen in my
first article that Dr. Currie used the cold affusion at the exacerba-
tion of the fever, which is ordinarily near the close of the day.
That is the time or liour at which, in health, the regular diurnal
temperature is highest. If he repeats the affusion in twenty-four
hours, it is at the time of the ordinary second diurnal elevation
of temperature, with which a fever case very nearly corresponds.
This diurnal rise and fall of temperature does not belong alone
to animal bodies. From noon until 2 or 3 o'clock the tempera-
ture of our atmosphere is ordinarily at its highest; and at or
about daybreak is the coldest hour of the twenty-four. We be-
lieve that this diurnal variation in the temperature of our atmos-
phere, as also the diurnal variation of temperature in animal
bodies, is influenced and controlled by electrical forces. We can
not change the law of these forces in an animal body any more
than we can change it as to the temperature of the earth.

I do not think that the cold-water treatment of fevers now
pursued in Germany will ever become general ; indeed I fear that
very few physicians will ever give it a trial; but knowing as I
do, after forty three-years' experience, the great value of cold

26

402 Appendix,

water in the treatment of fevers when practiced according to
Carrie's method, I would urge upon every physician to give Dr.
Currie's method a fair trial. Where a bath-tub can not be ob-
tained, I have a large washing-tub filled half full of fresh cold
water, in which the patient sits, and then cold water is poured
from a pitcher over the back, chest, and limbs. The pouring is
continued until the temperature is reduced. I have had to repeat
it as often as four times within twenty-four hours; but in a large
majority of cases twice a day was sufficient, sometimes once suf-
ficed. The reduction of temperature in fever cases is not all that
ought to be looked to. So soon as a fever is developed or begins
to be developed, waste or the disintegration of the living tissues
commences. The elimination of this disintegration (effete matter)
is even of higher consideration than the reduction of temperature.
Cold baths or cold affusions, carried out according to Currie's
method, put th^ skin in a more healthy condition, and thus
enable it to throw off a larger amount of carbonic acid; so far
and to that extent assisting the lungs in the process of purifying
the blood by throwing off effete matter in the form of carbonic
acid.

There is another elimination of even greater consequence, as
it is more under our control. I here refer to the action of the
liver in the process of converting the effete matter brought to it
along with the volume of blood through the portal vein into bile.

I will quote Liebermeister as to the use of calomel in typhoid
fever. Of quinine he says, "The admirable investigations of
Binz did well nigh establish the claim of quinine to be considered
as a specific in all infectious diseases. Except in malarial dis-
eases, however, it appears that this influence, if indeed it does
exist, can not be obtained short of doses that may not be used
with the human family. My own experience, at least after treat-
ing more than fifteen hundred cases with quinine in doses that
would formerly have been considered as dangerous to life, gives
no result that would indicate any specific influence of this drug
over typhoid fever, nor any power to cut the fever short at any
stage." My own experience fully accords with this last quota-
tion.

As to calomel in typhoid fever he says, " Since the favorable
effects of calomel on the large majority of cases was demon-

Appendix. 403

strated, I have given this medicine, with but few exceptions, to
every case of the fever, admitted before the ninth day of the
disease. I usually give three or four eight-grain doses during
the first twenty-four hours. After having employed this method
now on about eight hundred patients, I still feel that I have
every reason to continue it and to recommend it to others."

Liebermeister details in a careful manner his observations,
gives statistical tables of comparison between iodine and calomel,
and the non-specific treatment; the result of which is, that under
the calomel treatment the mortality was less than by any other
treatment; and also, that under the use of calomel a majority
of typhoid-fever cases was cut short, many of them not extend-
ing beyond the eleventh day, when convalescence began.

My own experience confirms the truth of Liebermeister's
observations. I found, however, that whatever was to be done,
as to cutting short the fever, must be done within the first week
or ten days.

In preparing an individual for inoculation with smallpox
matter we have this advantage, that we have our subject in a
healthy condition. In fever cases the first thing we know is that
the mischief has begun. Now I claim that we can prepare the
system of a patient within the first week, so that the fever will
be cut short.

In typhoid-fever cases I use calomel in conjunction with cold
water. My practice has been to give five grains of calomel every
six hours until the liver acts efiiciently — as will appear from the
bile which passes off with the stools. If diarrhea occurs, as
frequently happens in typhoid-fever cases, then I combine five
grains of Dover's powder with the calomel. This will arrest the
diarrhea and promote the secretion and excretion of bile. Un-
der this treatment, combined with that of Dr. Currie, as already
detailed, I maintain that typhoid fever cases may be cut short
and made to begin to convalesce by the twelfth or thirteenth
day. A few obstinate cases may continue for a longer time.
In fevers of a miasmatic origin, whether intermittent or remit-
tent, may be cut short in a much shorter time.

In the latter case, I use quinine after the fever has been cut
short. This I do because all miasmatic fevers or ailments are
periodical, and apt to return.

V