Chapter V: Preface (5)

4. It generally occurs when the lungs are in a passive state; as in sitting, walking, and more frequently in lying. Many of the cases that I have known, have occurred during _sleep_, in the middle of the night.

From these facts, is it not probable that the common salt, by acting primarily and with great force upon the throat, extends its stimulus to the bleeding vessel, and by giving it a tone, checks the further effusion of blood?

I shall only add to this conjecture the following observations:

1. I have never known the common salt perform a cure, where the hæmorrhage from the lungs has been a symptom of a confirmed consumption. But even in this case it gives a certain temporary relief.

2. The exhibition of common salt in the hæmoptysis, should by no means supersede the use of occasional bleeding when indicated by plethora, nor of that diet which the state of the pulse, or of the stomach, may require.

3. I have given the common salt in one case with success, in a hæmorrhage from the stomach, accompanied by a vomiting; and have heard of several cases in which it has been supposed to have checked a discharge of blood from the nose and uterus, but I can say nothing further in its favour in these last hæmorrhages, from my own experience.

It may perhaps serve to lessen the prejudices of physicians against adopting improvements in medicine, that are not recommended by the authority of colleges or universities, to add, that we are indebted to an old woman, for the discovery of the efficacy of common salt in the cure of hæmoptysis.

THOUGHTS

UPON

THE CAUSE AND CURE

OF THE

_PULMONARY CONSUMPTION_.

The ancient Jews used to say, that a man does not fulfil his duties in life, who passes through it, without building a house, planting a tree, and leaving a child behind him. A physician, in like manner, should consider his obligations to his profession and society as undischarged, who has not attempted to lessen the number of incurable diseases. This is my apology for presuming to make the consumption the object of a medical inquiry.

Perhaps I may suggest an idea, or fact, that may awaken the ideas and facts which now lie useless in the memories or common-place books of other physicians; or I may direct their attention to some useful experiments upon this subject.

I shall begin my observations upon the consumption, by remarking,

1. That it is unknown among the Indians in North-America.

2. It is scarcely known by those citizens of the United States, who live in the _first_ stage of civilized life, and who have lately obtained the title of the _first settlers_.

The principal occupations of the Indian consist in war, fishing, and hunting. Those of the first settler, are fishing, hunting, and the laborious employments of subduing the earth, cutting down forests, building a house and barn, and distant excursions, in all kinds of weather, to mills and courts, all of which tend to excite and preserve in the system, something like the Indian vigour of constitution.

3. It is less common in country places than in cities, and increases in both, with intemperance and sedentary modes of life.

4. Ship and house carpenters, smiths, and all those artificers whose business requires great exertions of strength in the _open_ air, in _all_ seasons of the year, are less subject to this disease, than men who work under cover, and at occupations which do not require the constant action of their limbs.

5. Women, who sit more than men, and whose work is connected with less exertion, are most subject to the consumption.

From these facts it would seem, that the most probable method of curing the consumption, is to revive in the constitution, by means of exercise or labour, that vigour which belongs to the Indians, or to mankind in their first stage of civilization.

The efficacy of these means of curing consumption will appear, when we inquire into the relative merit of the several remedies which have been used by physicians in this disease.

I shall not produce among these remedies the numerous receipts for syrups, boluses, electuaries, decoctions, infusions, pills, medicated waters, powders, draughts, mixtures, and diet-drinks, which have so long and so steadily been used in this disease; nor shall I mention as a remedy, the best accommodated diet, submitted to with the most patient self-denial; for not one of them all, without the aid of exercise, has ever, I believe, cured a single consumption.

1. SEA-VOYAGES have cured consumptions; but it has been only when they have been so long, or so frequent, as to substitute the long continuance of gentle, to violent degrees of exercise of a shorter duration, or where they have been accompanied by some degree of the labour and care of navigating the ship.

2. A CHANGE OF CLIMATE has often been prescribed for the cure of consumptions, but I do not recollect an instance of its having succeeded, except when it has been accompanied by exercise, as in travelling, or by some active laborious pursuit.

Doctor Gordon of Madeira, ascribes the inefficacy of the air of Madeira in the consumption, in part to the difficulty patients find of using exercise in carriages, or even on horseback, from the badness of the roads in that island.

3. JOURNIES have often performed cures in the consumption, but it has been chiefly when they have been long, and accompanied by difficulties which have roused and invigorated the powers of the mind and body.

4. VOMITS and NAUSEATING MEDICINES have been much celebrated for the cure of consumptions. These, by procuring a temporary determination to the surface of the body, so far lessen the pain and cough, as to enable patients to use profitable exercise. Where this has not accompanied or succeeded the exhibition of vomits, I believe they have seldom afforded any _permanent_ relief.

5. BLOOD-LETTING has often relieved consumptions; but it has been only by removing the troublesome symptoms of inflammatory diathesis, and thereby enabling the patients to use exercise, or labour, with advantage.

6. VEGETABLE BITTERS and some of the STIMULATING GUMS have in some instances afforded relief in consumptions; but they have done so only in those cases where there was great debility, accompanied by a total absence of inflammatory diathesis. They have most probably acted by their tonic qualities, as substitutes for labour and exercise.

7. A PLENTIFUL and REGULAR PERSPIRATION, excited by means of a flannel shirt, worn next to the skin, or by means of a stove-room, or by a warm climate, has in many instances _prolonged_ life in consumptive habits; but all these remedies have acted as palliatives only, and thereby have enabled the consumptive patients to enjoy the more beneficial effects of exercise.

8. BLISTERS, SETONS, and ISSUES, by determining the perspirable matter from the lungs to the surface of the body, lessen pain and cough, and thereby prepare the system for the more salutary effects of exercise.

9. The effects of SWINGING upon the pulse and respiration, leave us no room to doubt of its being a tonic remedy, and therefore a safe and agreeable substitute for exercise.

From all these facts it is evident, that the remedies for consumptions must be sought for in those _exercises and employments which give the greatest vigour to the constitution_. And here I am happy in being able to produce several facts which demonstrate the safety and certainty of this method of cure.

During the late war, I saw three instances of persons in confirmed consumptions, who were perfectly cured by the hardships of a military life. They had been my patients previously to their entering into the army. Besides these, I have heard of four well-attested cases of similar recoveries from nearly the same remedies. One of these was the son of a farmer in New-Jersey, who was sent to sea as the last resource for a consumption. Soon after he left the American shore, he was taken by a British cruiser, and compelled to share in all the duties and hardships of a common sailor. After serving in this capacity for twenty-two months, he made his escape, and landed at Boston, from whence he travelled on foot to his father's house (nearly four hundred miles), where he arrived in perfect health.

Doctor Way of Wilmington informed me, that a certain Abner Cloud, who was reduced so low by a pulmonary consumption as to be beyond all relief from medicine, was so much relieved by sleeping in the open air, and by the usual toils of building a hut, and improving a farm, in the unsettled parts of a new country in Pennsylvania, that he thought him in a fair way of a perfect recovery.

Doctor Latimer of Wilmington had been long afflicted with a cough and an occasional hæmoptysis. He entered into the American army as a surgeon, and served in that capacity till near the end of the war; during which time he was perfectly free from all pulmonary disease. The spitting of blood returned soon after he settled in private practice. To remedy this complaint, he had recourse to a low diet, but finding it ineffectual, he partook liberally of the usual diet of healthy men, and he now enjoys a perfect exemption from it.

It would be very easy to add many other cases, in which labour, the employments of agriculture, and a life of hardship by sea and land, have prevented, relieved, or cured, not only the consumption, but pulmonary diseases of all kinds.

To the cases that have been mentioned, I shall add only one more, which was communicated to me by the venerable Doctor Franklin, whose conversation at all times conveyed instruction, and not less in medicine than upon other subjects. In travelling, many years ago, through New-England, the doctor overtook the post-rider; and after some inquiries into the history of his life, he informed him that he was bred a shoe-maker; that his confinement, and other circumstances, had brought on a consumption, for which he was ordered by a physician to ride on horseback. Finding this mode of exercise too expensive, he made interest, upon the death of an old post-rider, to succeed to his appointment, in which he perfectly recovered his health in two years. After this he returned to his old trade, upon which his consumption returned. He again mounted his horse, and rode post in all seasons and weathers, between New-York and Connecticut river (about 140 miles), in which employment he continued upwards of thirty years, in perfect health.

These facts, I hope, are sufficient to establish the advantages of restoring the original vigour of the constitution, in every attempt to effect a radical cure of consumption.

But how shall these remedies be applied in the time of peace, or in a country where the want of woods, and brooks without bridges, forbid the attainment of the laborious pleasures of the Indian mode of hunting; or where the universal extent of civilization does not admit of our advising the toils of a new settlement, and improvements upon bare creation? Under these circumstances, I conceive substitutes may be obtained for each of them, nearly of equal efficacy, and attainable with much less trouble.

1. Doctor Sydenham pronounced riding on horseback, to be as certain a cure for consumptions as bark is for an intermitting fever. I have no more doubt of the truth of this assertion, than I have that inflammatory fevers are now less frequent in London than they were in the time of Doctor Sydenham. If riding on horseback in consumptions has ceased to be a remedy in Britain, the fault is in the patient, and not in the remedy. "It is a sign that the stomach requires milk (says Doctor Cadogan), when it cannot bear it." In like manner, the inability of the patient to bear this manly and wholesome exercise, serves only to demonstrate the necessity and advantages of it. I suspect the same objections to this exercise which have been made in Britain, will not occur in the United States of America; for the Americans, with respect to the symptoms and degrees of epidemic and chronic diseases, appear to be nearly in the same state that the inhabitants of England were in the seventeenth century. We find, in proportion to the decline of the vigour of the body, that many occasional causes produce fever and inflammation, which would not have done it a hundred years ago.

2. The laborious employments of agriculture, if steadily pursued, and accompanied at the same time by the simple, but wholesome diet of a farmhouse, and a hard bed, would probably afford a good substitute for the toils of a savage or military life.

3. Such occupations or professions as require constant labour or exercise in the open air, in all kinds of weather, may easily be chosen for a young man who, either from hereditary predisposition, or an accidental affection of the lungs, is in danger of falling into a consumption. In this we should imitate the advice given by some wise men, always to prefer those professions for our sons, which are the least favourable to the corrupt inclinations of their hearts. For example, where an undue passion for money, or a crafty disposition, discover themselves in early life, we are directed to oppose them by the less profitable and more disinterested professions of divinity or physic, rather than cherish them by trade, or the practice of the law. Agreeably to this analogy, weakly children should be trained to the laborious, and the robust, to the sedentary occupations. From a neglect of this practice, many hundred apprentices to taylors, shoemakers, conveyancers, watchmakers, silversmiths, and mantua-makers, perish every year by consumptions.

4. There is a case recorded by Dr. Smollet, of the efficacy of the cold bath in a consumption; and I have heard of its having been used with success, in the case of a negro man, in one of the West-India islands. To render this remedy useful, or even safe, it will be necessary to join it with labour, or to use it in degrees that shall prevent the alternation of the system with vigour and debility; for I take the cure of consumption ultimately to depend upon the simple and constant action of tonic remedies. It is to be lamented that it often requires so much time, or such remedies to remove the inflammatory diathesis, which attends the first stage of consumption, as to reduce the patient too low to make use of those tonic remedies afterwards, which would effect a radical cure.

If it were possible to graduate the tone of the system by means of a scale, I would add, that to cure consumption, the system should be raised to the highest degree of this scale. Nothing short of an equilibrium of tone, or a free and vigorous action of every muscle and viscus in the body, will fully come up to a radical cure of this disease.

In regulating the diet of consumptive patients, I conceive it to be as necessary to feel the pulse, as it is in determining when and in what quantity to draw blood. Where inflammatory diathesis prevails, a vegetable diet is certainly proper; but where the patient has _escaped_, or _passed_ this stage of the disease, I believe a vegetable diet alone to be injurious; and am sure a moderate quantity of animal food may be taken with advantage.

The presence or absence of this inflammatory diathesis, furnishes the indications for administering or refraining from the use of the bark and balsamic medicines. With all the testimonies of their having done mischief, many of which I could produce, I have known several cases in which they have been given with obvious advantage; but it was only when there was a total absence of inflammatory diathesis.

Perhaps the remedies I have recommended, and the opinions I have delivered, may derive some support from attending to the analogy of ulcers on the legs, and in other parts of the body. The first of these occur chiefly in habits debilitated by spiritous liquors, and the last frequently in habits debilitated by the scrophula. In curing these diseases, it is in vain to depend upon internal or external medicines. The whole system must be strengthened, or we do nothing; and this is to be effected only by exercise and a generous diet.

In relating the facts that are contained in this inquiry, I wish I could have avoided reasoning upon them; especially as I am confident of the certainty of the facts, and somewhat doubtful of the truth of my reasonings.

I shall only add, that if the cure of consumptions should at last be effected by remedies in every respect the opposites of those palliatives which are now fashionable and universal, no more will happen than what we have already seen in the tetanus, the small-pox, and the management of fractured limbs.

Should this be the case, we shall not be surprised to hear of physicians, instead of prescribing any one, or all of the medicines formerly enumerated for consumptions, ordering their patients to exchange the amusements, or indolence of a city, for the toils of a country life; of their advising farmers to exchange their plentiful tables, and comfortable fire-sides, for the scanty but solid subsistence, and midnight exposure of the herdsman; or of their recommending, not so much the exercise of a _passive_ sea voyage, as the _active_ labours and dangers of a common sailor. Nor should it surprise us, after what we have seen, to hear patients relate the pleasant adventures of their excursions or labours, in quest of their recovery from this disease, any more than it does now to see a strong or well-shaped limb that has been broken; or to hear a man talk of his studies, or pleasures, during the time of his being inoculated and attended for the small-pox.

I will not venture to assert, that there does not exist a medicine which shall supply, at least in some degree, the place of the labour or exercises, whose usefulness in consumptions has been established by the facts that have been mentioned. Many instances of the analogous effects of medicines, and of exercise upon the human body, forbid the supposition. If there does exist in nature such a medicine, I am disposed to believe it will be found in the class of TONICS. If this should be the case, I conceive its strength, or its dose, must far exceed the present state of our knowledge or practice, with respect to the efficacy or dose of tonic medicines.

I except the disease, which arises from recent abscesses in the lungs, from the general observation which has been made, respecting the inefficacy of the remedies that were formerly enumerated for the cure of consumptions without labour or exercise. These abscesses often occur without being preceded by general debility, or accompanied by a consumptive diathesis, and are frequently cured by nature, or by very simple medicines.

OBSERVATIONS UPON WORMS

IN THE

ALIMENTARY CANAL,

AND UPON

ANTHELMINTIC MEDICINES.

With great diffidence I venture to lay before the public my opinions upon worms: nor should I have presumed to do it, had I not entertained a hope of thereby exciting further inquiries upon this subject.

When we consider how universally worms are found in all young animals, and how frequently they exist in the human body, without producing disease of any kind, it is natural to conclude, that they serve some useful and necessary purposes in the animal economy. Do they consume the superfluous aliment which all young animals are disposed to take, before they have been taught, by experience or reason, the bad consequences which arise from it? It is no objection to this opinion, that worms are unknown in the human body in some countries. The laws of nature are diversified, and often suspended under peculiar circumstances in many cases, where the departure from uniformity is still more unaccountable, than in the present instance. Do worms produce diseases from an _excess_ in their _number_, and an _error_ in their place, in the same manner that blood, bile, and air produce diseases from an _error_ in their place, or from _excess_ in their _quantities_? Before these questions are decided, I shall mention a few facts which have been the result of my own observations upon this subject.

1. In many instances, I have seen worms discharged in the small-pox and measles, from children who were in perfect health previously to their being attacked by those diseases, and who never before discovered a single symptom of worms. I shall say nothing here of the swarms of worms which are discharged in fevers of all kinds, until I attempt to prove that an idiopathic fever is never produced by worms.

2. Nine out of ten of the cases which I have seen of worms, have been in children of the grossest habits and most vigorous constitutions. This is more especially the case where the worms are dislodged by the small-pox and measles. Doctor Capelle of Wilmington, in a letter which I received from him, informed me, that in the livers of sixteen, out of eighteen rats which he dissected, he found a number of the tænia worms. The rats were fat, and appeared in other respects to have been in perfect health. The two rats in which he found no worms, he says, "were very lean, and their livers smaller in proportion than the others."

3. In weakly children, I have often known the most powerful anthelmintics given without bringing away a single worm. If these medicines have afforded any relief, it has been by their tonic quality. From this fact, is it not probable--the conjecture, I am afraid, is too bold, but I will risk it:--is it not probable, I say, that children are sometimes disordered from the want of worms? Perhaps the tonic medicines which have been mentioned, render the bowels a more quiet and comfortable asylum for them, and thereby provide the system with the means of obviating the effects of crapulas, to which all children are disposed. It is in this way that nature, in many instances, cures evil by evil. I confine the salutary office of worms only to that species of them which is known by the name of the round worm, and which occurs most frequently in children.

Is there any such disease as an idiopathic WORM-FEVER? The Indians in this country say there is not, and ascribe the discharge of worms to a fever, and not a fever to the worms[40].

[40] See the Inquiry into the Diseases of the Indians, p. 19.

By adopting this opinion, I am aware that I contradict the observations of many eminent and respectable physicians.

Doctor Huxham describes an epidemic pleurisy, in the month of March, in the year 1740, which he supposes was produced by his patients feeding upon some corn that had been injured by the rain the August before[41]. He likewise mentions that a number of people, and those too of the elderly sort[42], were afflicted at one time with worms, in the month of April, in the year 1743.

[41] Vol. II. of his Epidemics, p. 56.

[42] P. 136.

Lieutade gives an account of an epidemic worm-fever from Velchius, an Italian physician[43]; and Sauvages describes, from Vandermonde, an epidemic dysentery from worms, which yielded finally only to worm medicines[44]. Sir John Pringle, and Doctor Monro, likewise frequently mention worms as accompanying the dysentery and remitting fever, and recommend the use of calomel as an antidote to them.

[43] Vol. I. p. 76.

[44] Vol. II. p. 329.

I grant that worms appear more frequently in some epidemic diseases than in others, and oftener in some years than in others. But may not the same heat, moisture, and diet which produced the diseases, have produced the worms? And may not their discharge from the bowels have been occasioned in those epidemics, as in the small-pox and measles, by the increased heat of the body, by the want of nourishment, or by an anthelmintic quality being accidentally combined with some of the medicines that are usually given in fevers?

In answer to this, we are told that we often see the crisis of a fever brought on by the discharge of worms from the bowels by means of a purge, or by an anthelmintic medicine. Whenever this is the case, I believe it is occasioned by offending bile being dislodged by means of the purge, at the same time with the worms, or by the anthelmintic medicine (if not a purge) having been given on, or near one of the usual critical days of the fever. What makes the latter supposition probable is, that worms are seldom suspected in the beginning of fevers, and anthelmintic medicines seldom given, till every other remedy has failed of success; and this generally happens about the usual time in which fevers terminate in life or death.

It is very remarkable, that since the discovery and description of the hydrocephalus internus, we hear and read much less than formerly of worm-fevers. I suspect that disease of the brain has laid the foundation for the principal part of the cases of worm-fevers which are upon record in books of medicine. I grant that worms sometimes increase the danger from fevers, and often confound the diagnosis and prognosis of them, by a number of new and anomalous symptoms. But here we see nothing more than that complication of symptoms which often occurs in diseases of a very different and opposite nature.

Having rejected worms as the cause of fevers, I proceed to remark, that the diseases most commonly produced by them, belong to Dr. Cullen's class of NEUROSES. And here I might add, that there is scarcely a disease, or a symptom of a disease, belonging to this class, which is not produced by worms. It would be only publishing extracts from books, to describe them.

The _chronic_ and _nervous_ diseases of children, which are so numerous and frequently fatal, are, I believe, frequently occasioned by worms. There is no great danger, therefore, of doing mischief, by prescribing anthelmintic medicines in all our first attempts to cure their chronic and nervous diseases.

I have been much gratified by finding myself supported in the above theory of worm-fevers, by the late Dr. William Hunter, and by Dr. Butter, in his excellent treatise upon the infantile remitting fever.

I have taken great pains to find out, whether the presence of the different species of worms might not be discovered by certain peculiar symptoms; but all to no purpose. I once attended a girl of twelve years of age in a fever, who discharged four yards of a tænia, and who was so far from having discovered any peculiar symptom of this species of worms, that she had never complained of any other indisposition, than now and then a slight pain in the stomach, which often occurs in young girls from a sedentary life, or from errors in their diet. I beg leave to add further, that there is not a symptom which has been said to indicate the presence of worms of any kind, as the cause of a disease, that has not deceived me; and none oftener than the one that has been so much depended upon, viz. the picking of the nose. A discharge of worms from the bowels, is, perhaps, the only symptom that is pathognomonic of their presence in the intestines.

I shall now make a few remarks upon anthelmintic remedies.

But I shall first give an account of some experiments which I made in the year 1771, upon the common earth-worm, in order to ascertain the anthelmintic virtues of a variety of substances. I made choice of the earth-worm for this purpose, as it is, according to naturalists, nearly the same in its structure, manner of subsistence, and mode of propagating its species, with the round worm of the human body.

In the first column I shall set down, under distinct heads, the substances in which worms were placed; and in the second and third columns the _time_ of their death, from the action of these substances upon them.

I. BITTER AND ASTRINGENT | HOURS. | MINUTES.
SUBSTANCES. | |
| |
Watery infusion of aloes | 2 | 48
---- of rhubarb | 1 | 30
---- of Peruvian bark | 1 | 30
| |
II. PURGES. | |
| |
Watery infusion of jalap | 1 | --
------ bear's-foot | 1 | 17
------ gamboge | 1 | --
| |
III. SALTS. | |
| |
1. _Acids._ | |
| |
Vinegar | -- | 1-1/2 convulsed.
Lime juice | -- | 1
Diluted nitrous acid | -- | 1-1/2
| |
2. _Alkali._ | |
| |
A watery solution of salt of tartar | -- | 2 convulsed, throwing
| | up a mucus
| | on the surface of
3. _Neutral Salts._ | | the water.
| |
In a watery solution of common | |
salt | -- | 1 convulsed.
---- of nitre | -- | ditto.
---- of sal diuretic | -- | ditto.
---- of sal ammoniac | -- | 1-1/2
---- of common salt and sugar. | -- | 4
| |
4. _Earthy and metallic salts._ | |
| |
In a watery solution of Epsom salt | -- | 15-1/2
---- of rock alum | -- | 10
---- of corrosive sublimate | -- | 1-1/2 convulsed.
---- of calomel | -- | 49
---- of turpeth mineral | -- | 1 convulsed.
---- of sugar of lead | -- | 3
---- of green vitriol | -- | 1
---- of blue vitriol | -- | 10
---- of white vitriol | -- | 30
IV. METALS. | |
| |
Filings of steel | -- | 2-1/2
Filings of tin | 1 | --
| |
V. CALCAREOUS EARTH. | |
| |
Chalk | 2 | --
| |
VI. NARCOTIC SUBSTANCES. | |
| |
Watery infusion of opium | -- | 11-1/2 convulsed.
---- of Carolina pink-root | -- | 33
---- of tobacco | -- | 14
| |
VII. ESSENTIAL OILS. | |
| |
Oil of wormwood | -- | 3 convulsed.
---- of mint | -- | 3
---- of caraway seed | -- | 3
---- of amber | -- | 1-1/2
---- of anniseed | -- | 4-1/2
---- of turpentine | -- | 6
| |
VIII. ARSENIC. | |
| |
A watery solution of white | near |
arsenic | 2 | --
| |
IX. FERMENTED LIQUORS. | |
| |
In Madeira wine | -- | 3 convulsed.
Claret | -- | 10
| |
X. DISTILLED SPIRIT. | |
| |
Common rum | -- | 1 convulsed.
| |
XI. THE FRESH JUICES OF RIPE FRUITS. | |
| |
The juice of red cherries | -- | 5-1/2
---- of black do. | -- | 5
---- of red currants | -- | 2-1/2
---- of gooseberries | -- | 3-1/2
---- of whortleberries | -- | 12
---- of blackberries | -- | 7
---- of raspberries | -- | 5-1/2
---- of plums | -- | 13
---- of peaches | -- | 25
The juice of water-melons, no | |
effect. | -- | --
| |
XII. SACCHARINE SUBSTANCES. | |
| |
Honey | -- | 7
Molasses | -- | 7
Brown sugar | -- | 30
Manna | -- | 2-1/2
| |
XIII. IN AROMATIC SUBSTANCES. | |
| |
Camphor | -- | 5
Pimento | -- | 3-1/2
Black pepper | -- | 45
| |
XIV. FOETID SUBSTANCES | |
| |
Juice of onions | -- | 3-1/2
Watery infusion of assaf[oe]tida | -- | 27
---- Santonicum, or worm seed | 1 | --
| |
XV. MISCELLANEOUS SUBSTANCES. | |
| |
Sulphur mixed with oil | 2 | --
Æthiops mineral | 2 | --
Sulphur | 2 | --
Solution of gunpowder | -- | 1-1/2
---- of soap | -- | 19
Oxymel of squills | -- | 3-1/2
Sweet oil | 2 | 30

In the application of these experiments to the human body, an allowance must always be made for the alteration which the several anthelmintic substances that have been mentioned, may undergo from mixture and diffusion in the stomach and bowels.

In order to derive any benefit from these experiments, as well as from the observations that have been made upon anthelmintic medicines, it will be necessary to divide them into such as act,

1. Mechanically,

2. Chemically upon worms; and,

3. Into those which possess a power composed of chemical and mechanical qualities.

1. The mechanical medicines act indirectly and directly upon the worms.

Those which act _indirectly_ are, vomits, purges, bitter and astringent substances, particularly aloes, rhubarb, bark, bear's-foot, and worm-seed. Sweet oil acts indirectly and very feebly upon worms. It was introduced into medicine from its efficacy in destroying the botts in horses; but the worms which infest the human bowels, are of a different nature, and possess very different organs of life from those which are found in the stomach of a horse.

Those mechanical medicines which act _directly_ upon the worms, are cowhage[45] and powder of tin. The last of these medicines has been supposed to act chemically upon the worms, from the arsenic which adheres to it; but from the length of time a worm lived in a solution of white arsenic, it is probable the tin acts altogether mechanically upon them.

[45] Dolichos Pruriens, of Linnæus.

2. The medicines which act chemically upon worms, appear, from our experiments, to be very numerous.

Nature has wisely guarded children against the morbid effects of worms, by implanting in them an early appetite for common salt, ripe fruits, and saccharine substances; all of which appear to be among the most speedy and effectual poisons for worms.

Let it not be said, that nature here counteracts her own purposes. Her conduct in this business is conformable to many of her operations in the human body, as well as throughout all her works. The bile is a necessary part of the animal fluids, and yet an appetite for ripe fruits seems to be implanted chiefly to obviate the consequences of its excess, or acrimony, in the summer and autumnal months.

The use of common salt as an anthelmintic medicine, is both ancient and universal. Celsus recommends it. In Ireland it is a common practice to feed children, who are afflicted by worms, for a week or two upon a salt-sea weed, and when the bowels are well charged with it, to give a purge of wort in order to carry off the worms, after they are debilitated by the salt diet.

I have administered many pounds of common salt coloured with cochineal, in doses of half a drachm, upon an empty stomach in the morning, with great success in destroying worms.

Ever since I observed the effects of sugar and other sweet substances upon worms, I have recommended the liberal use of all of them in the diet of children, with the happiest effects. The sweet substances probably act in preventing the diseases from worms in the stomach only, into which they often insinuate themselves, especially in the morning. When we wish to dislodge worms from the bowels by sugar or molasses, we must give these substances in large quantities, so that they may escape in part the action of the stomach upon them.

I can say nothing from my own experience of the efficacy of the mineral salts, composed of copper, iron, and zinc, combined with vitriolic acid, in destroying worms in the bowels. Nor have I ever used the corrosive sublimate in small doses as an anthelmintic.

I have heard of well-attested cases of the efficacy of the oil of turpentine in destroying worms.

The expressed juices of onions and of garlic are very common remedies for worms. From one of the experiments, it appears that the onion juice possesses strong anthelmintic virtues.

I have often prescribed a tea-spoonful of gunpowder in the morning upon an empty stomach, with obvious advantage. The active medicine here is probably the nitre.

I have found a syrup made of the bark of the Jamaica cabbage-tree[46], to be a powerful as well as a most agreeable anthelmintic medicine. It sometimes purges and vomits, but its good effects may be obtained without giving it in such doses as to produce these evacuations.

[46] Geoffrea, of Linnæus.

There is not a more _certain_ anthelmintic than Carolina pink-root[47]. But as there have been instances of death having followed excessive doses of it, imprudently administered, and as children are often affected by giddiness, stupor, and a redness and pain in the eyes after taking it, I acknowledge that I have generally preferred to it, less certain, but more safe medicines for destroying worms.

[47] Spigelia Marylandica, of Linnæus.

3. Of the medicines whose action is compounded of mechanical and chemical qualities, calomel, jalap, and the powder of steel, are the principal.

Calomel, in order to be effectual, must be given in large doses. It is a safe and powerful anthelmintic. Combined with jalap, it often brings away worms when given for other purposes.

Of all the medicines that I have administered, I know of none more safe and certain than the simple preparations of iron, whether they be given in the form of steel-filings or of the rust of iron. If ever they fail of success, it is because they are given in too small doses. I generally prescribe from five to thirty grains every morning, to children between one year, and ten years old; and I have been taught by an old sea-captain, who was cured of a tænia by this medicine, to give from two drachms to half an ounce of it, every morning, for three or four days, not only with safety, but with success.

I shall conclude this essay with the following remarks:

1. Where the action of medicines upon worms in the bowels does not agree exactly with their action upon the earth-worms in the experiments that have been related, it must be ascribed to the medicines being more or less altered by the action of the stomach upon them. I conceive that the superior anthelmintic qualities of pink-root, steel-filings, and calomel (all of which acted but slowly upon the earth-worms compared with many other substances) are in a great degree occasioned by their escaping the digestive powers unchanged, and acting in a concentrated state upon the worms.

2. In fevers attended with anomalous symptoms, which are supposed to arise from worms, I have constantly refused to yield to the solicitations of my patients, to abandon the indications of cure in the fever, and to pursue worms as the _principal_ cause of the disease. While I have adhered steadily to the usual remedies for the different states of fever, in all their stages, I have at the same time blended those remedies occasionally with anthelmintic medicines. In this I have imitated the practice of physicians in many other diseases, in which troublesome and dangerous symptoms are pursued, without seducing the attention from the original disease. The anthelmintic medicines prescribed in these cases, should not be the rust of iron, and common salt, which are so very useful in chronic diseases from worms, but calomel and jalap, and such other medicines as aid in the cure of fevers.

AN ACCOUNT

OF THE

_EXTERNAL USE OF ARSENIC_,

IN THE

CURE OF CANCERS.

A few years ago, a certain Doctor Hugh Martin, a surgeon of one of the Pennsylvania regiments stationed at Pittsburg, during the latter part of the late war, came to this city, and advertised to cure cancers with a medicine which he said he had discovered in the woods, in the neighbourhood of the garrison. As Dr. Martin had once been my pupil, I took the liberty of waiting upon him, and asked him some questions respecting his discovery. His answers were calculated to make me believe, that his medicine was of a vegetable nature, and that it was originally an Indian remedy. He showed me some of the medicine, which appeared to be the powder of a well-dried root of some kind. Anxious to see the success of this medicine in cancerous sores, I prevailed upon the doctor to admit me to see him apply it in two or three cases. I observed, in some instances, he applied a powder to the parts affected, and in others only touched them with a feather dipped in a liquid which had a white sediment, and which he made me believe was the vegetable root diffused in water. It gave me great pleasure to witness the efficacy of the doctor's applications. In several cancerous ulcers, the cures he performed were complete. Where the cancers were much connected with the lymphatic system, or accompanied with a scrophulous habit of body, his medicine always failed, and, in some instances, did evident mischief.

Anxious to discover a medicine that promised relief in even a few cases of cancers, and supposing that all the caustic vegetables were nearly alike, I applied the phytolacca or poke-root, the stramonium, the arum, and one or two others, to foul ulcers, in hopes of seeing the same effects from them which I had seen from Doctor Martin's powder; but in these I was disappointed. They gave some pain, but performed no cures. At length I was furnished by a gentleman from Pittsburg with a powder which I had no doubt, from a variety of circumstances, was of the same kind as that used by Dr. Martin. I applied it to a fungous ulcer, but without producing the degrees of pain, inflammation, or discharge, which I had been accustomed to see from the application of Dr. Martin's powder. After this, I should have suspected that the powder was not a _simple_ root, had not the doctor continued upon all occasions to assure me, that it was wholly a vegetable preparation.

In the beginning of the year 1784, the doctor died, and it was generally believed that his medicine had died with him. A few weeks after his death I procured, from one of his administrators, a few ounces of the doctor's powder, partly with a view of applying it to a cancerous sore which then offered, and partly with a view of examining it more minutely than I had been able to do during the doctor's life. Upon throwing the powder, which was of a brown colour, upon a piece of white paper, I perceived distinctly a number of white particles scattered through it. I suspected at first that they were corrosive sublimate, but the usual tests of that metallic salt soon convinced me, that I was mistaken. Recollecting that arsenic was the basis of most of the celebrated cancer powders that have been used in the world, I had recourse to the tests for detecting it. Upon sprinkling a small quantity of the powder upon some coals of fire, it emitted the garlick smell so perceptibly as to be known by several persons whom I called into the room where I made the experiment, and who knew nothing of the object of my inquiries. After this, with some difficulty I picked out about three or four grains of the white powder, and bound them between two pieces of copper, which I threw into the fire. After the copper pieces became red hot, I took them out of the fire, and when they had cooled, discovered an evident whiteness imparted to both of them. One of the pieces afterwards looked like dull silver. These two tests have generally been thought sufficient to distinguish the presence of arsenic in any bodies; but I made use of a third, which has lately been communicated to the world by Mr. Bergman, and which is supposed to be in all cases infallible.

I infused a small quantity of the powder in a solution of a vegetable alkali in water for a few hours, and then poured it upon a solution of blue vitriol in water. The colour of the vitriol was immediately changed to a beautiful green, and afterwards precipitated.

I shall close this paper with a few remarks upon this powder, and upon the cure of cancers and foul ulcers of all kinds.

1. The use of caustics in cancers and foul ulcers is very ancient, and universal. But I believe _arsenic_ to be the most efficacious of any that has ever been used. It is the basis of Plunket's and probably of Guy's well-known cancer powders. The great art of applying it successfully, is to dilute and mix it in such a manner as to mitigate the violence of its action. Doctor Martin's composition was happily calculated for this purpose. It gave less pain than the common or lunar caustic. It excited a moderate inflammation, which separated the morbid from the sound parts, and promoted a plentiful afflux of humours to the sore during its application. It seldom produced an escar; hence it insinuated itself into the deepest recesses of the cancers, and frequently separated those fibres in an unbroken state, which are generally called the roots of the cancer. Upon this account, I think, in some ulcerated cancers it is to be preferred to the knife. It has no action upon the sound skin. This Doctor Hall proved, by confining a small quantity of it upon his arm for many hours. In those cases where Doctor Martin used it to extract cancerous or schirrous tumours that were not ulcerated, I have reason to believe that he always broke the skin with Spanish flies.

2. The arsenic used by the doctor was the pure white arsenic. I should suppose from the examination I made of the powder with the eye, that the proportion of arsenic to the vegetable powder, could not be more than one-fortieth part of the whole compound. I have reason to think that the doctor employed different vegetable substances at different times. The vegetable matter with which the arsenic was combined in the powder which I used in my experiments, was probably nothing more than the powder of the root and berries of the solanum lethale, or deadly nightshade. As the principal, and perhaps the only design of the vegetable addition was to blunt the activity of the arsenic, I should suppose that the same proportion of common wheat flour as the doctor used of his caustic vegetables, would answer nearly the same purpose. In those cases where the doctor applied a feather dipped in a liquid to the sore of his patient, I have no doubt but his phial contained nothing but a weak solution of arsenic in water. This is no new method of applying arsenic to foul ulcers. Doctor Way of Wilmington has spoken in the highest terms to me of a wash for foulnesses on the skin, as well as old ulcers, prepared by boiling an ounce of white arsenic in two quarts of water to three pints, and applying it once or twice a day.

3. I mentioned, formerly, that Doctor Martin was often unsuccessful in the application of his powder. This was occasioned by his using it indiscriminately in _all_ cases. In schirrous and cancerous tumours, the knife should always be preferred to the caustic. In cancerous ulcers attended with a scrophulous or a bad habit of body, such particularly as have their seat in the neck, in the breasts of females, and in the axillary glands, it can only protract the patient's misery. Most of the cancerous sores cured by Doctor Martin were seated on the nose, or cheeks, or upon the surface or extremities of the body. It remains yet to discover a cure for cancers that taint the fluids, or infect the whole lymphatic system. This cure I apprehend must be sought for in diet, or in the long use of some internal medicine.

To pronounce a disease incurable, is often to render it so. The intermitting fever, if left to itself, would probably prove frequently, and perhaps more speedily fatal than cancers. And as cancerous tumours and sores are often neglected, or treated improperly by injudicious people, from an apprehension that they are incurable (to which the frequent advice of physicians "to let them alone," has no doubt contributed), perhaps the introduction of arsenic into regular practice as a remedy for cancers, may invite to a more early application to physicians, and thereby prevent the deplorable cases that have been mentioned, which are often rendered so by delay or unskilful management.

4. It is not in cancerous sores only that Doctor Martin's powder has been found to do service. In sores of all kinds, and from a variety of causes, where they have been attended with fungous flesh or callous edges, I have used the doctor's powder with advantage.

I flatter myself that I shall be excused in giving this detail of a _quack_ medicine, when we reflect that it was from the inventions and temerity of quacks, that physicians have derived some of their most active and most useful medicines.

OBSERVATIONS

UPON

_THE TETANUS_.

For a history of the different names and symptoms of this disease, I beg leave to refer the reader to practical books, particularly to Doctor Cullen's First Lines. My only design in this inquiry, is to deliver such a theory of the disease, as may lead to a new and successful use of old and common remedies for it.

All the remote and predisposing causes of the tetanus act by inducing preternatural debility, and irritability in the muscular parts of the body. In many cases, the remote causes act alone, but they more frequently require the co-operation of an exciting cause. I shall briefly enumerate, without discriminating them, or pointing out when they act singly, or when in conjunction with each other.

I. Wounds on different parts of the body are the most frequent causes of this disease. It was formerly supposed it was the effect only of a wound, which partially divided a tendon, or a nerve; but we now know it is often the consequence of læsions which affect the body in a superficial manner. The following is a list of such wounds and læsions as have been known to induce the disease:

1. Wounds in the soles of the feet, in the palms of the hands, and under the nails, by means of nails or splinters of wood.

2. Amputations, and fractures of limbs.

3. Gun-shot wounds.

4. Venesection.

5. The extraction of a tooth, and the insertion of new teeth.

6. The extirpation of a schirrous.

7. Castration.

8. A wound on the tongue.

9. The injury which is done to the feet by frost.

10. The injury which is sometimes done to one of the toes, by stumping it (as it is called) in walking.

11. Cutting a nail too closely. Also,

12. Cutting a corn too closely.

13. Wearing a shoe so tight as to abrade the skin of one of the toes.

14. A wound, not more than an eighth part of an inch, upon the forehead.

15. The stroke of a whip upon the arm, which only broke the skin.

16. Walking too soon upon a broken limb.

17. The sting of a wasp upon the glands penis.

18. A fish bone sticking in the throat.

19. Cutting the navel string in new-born infants.

Between the time in which the body is thus wounded or injured, and the time in which the disease makes its appearance, there is an interval which extends from one day to six weeks. In the person who injured his toe by stumping it in walking, the disease appeared the next day. The trifling wound on the forehead which I have mentioned, produced both tetanus and death, the day after it was received. I have known two instances of tetanus, from running nails in the feet, which did not appear until six weeks afterwards. In most of the cases of this disease from wounds which I have seen, there was a total absence of pain and inflammation, or but very moderate degrees of them, and in some of them the wounds had entirely healed, before any of the symptoms of the disease had made their appearance. Wounds and læsions are most apt to produce tetanus, after the long continued application of heat to the body; hence its greater frequency, from these causes, in warm than in cold climates, and in warm than in cold weather, in northern countries.