The History of the Medical Department of Transylvania University Part 4

"The procession first moved in a circle around the lawn where it was formed, at which time the bells in the various churches in town commenced a merry peal which continued till the procession reached the place where the ceremony was performed. The military escort then formed a hollow square, within which the whole civic procession was enclosed. Thousands of anxious and delighted spectators were on the outside, among whom we were gratified to see a large concourse of ladies, for whose accommodation the marshal had directed the adjacent market-house to be appropriated.

"Doctor Caldwell then delivered a highly interesting and appropriate address.

"A Federal salute was fired at sunrise, and seven guns when the first stone sill was laid, indicating the seven sections of the road under contract."

Doctor Caldwell spoke in polished and eloquent phrase of the advantages accruing to Lexington and the whole adjacent country from the establishment of this road. He prophesied also great benefit to Louisville therefrom.

We learn from the same old newspaper that Doctor Caldwell was announced to deliver a lecture, a few evenings later, at the first meeting of the "Lexington Lyceum," at the court house. The subject of the lecture was "The Moral and Incidental Influences of Railroads."

"Ladies and strangers" were invited to attend.

But in later days, in compet.i.tion with the steamboat, the newer and swifter mode of transportation--the railroad--has been gradually but surely restoring to the inland regions, and to Lexington, their lost prosperity. Our city has steadily risen to about seventeen thousand (1873), with a good prospect of a further increase of prosperity and population as railroads centering here may be extended. Then may we hope to put into active operation once more our time-honored Medical College, and to attract to it a creditable number of students. More particularly if, with the co-operation of the more enlightened members of our profession, an effort be faithfully made in the renovated college to bring about the much-needed reform in medical education, the necessity for which is now generally recognized. So that the mere fact of a student attending two courses of lectures, with other somewhat easy requisitions, may not ent.i.tle him to the degree of Doctor of Medicine, as has been too frequently the case amongst competing medical colleges. That full preparation and training, in a sufficient period of time, shall be required of the candidates into whose hands the health and lives of communities are to be committed.

On such a basis--when our city may have acquired increased facilities for clinical instruction, and when anatomical studies will not be cramped for want of means of demonstration--the old Medical College of Transylvania may revive under the wing of a people's educational inst.i.tution such as Transylvania is and always was--a "_State University_."

Difficulties in the procurement of a sufficient supply of material for anatomical instruction, coupled with the demand for clinical teaching which was beginning to be urged by the profession, forced themselves on the attention of the Medical Faculty of Transylvania before the year 1836-37. But in that year a determined effort was made, engineered and led by Professor Caldwell, to remove the Medical College to Louisville, that city having been induced by the earnest and eloquent appeals of Caldwell to offer it a large bonus. But for the early withdrawal of Doctor Dudley from this promising scheme, toward which he was at first inclined--because mainly of his difficulties in the supply of anatomical material--it would have been successful. But Doctor Dudley finally declined to remove, much to the mortification of Doctor Caldwell, who, in his last valedictory to the graduates of 1837, indulged in a very bitter impersonal-personal tirade against deception and mendacity, aimed at Doctor Dudley--not saying openly to his colleague "thou art the man"--but hoping "the cap would fit him" and find its place. The Trustees of the University, of course, and influential citizens, violently opposed the proposed change. Doctor Caldwell was arraigned before the Board on charges preferred by Doctor Dudley, the princ.i.p.al of which was that he had been engaged in the enterprise of originating a rival medical college in Louisville while he was yet a professor in the Transylvania College and under oath to support it. Doctor Caldwell, disdaining to answer the summons of the Board, was, after a long and full investigation of the evidence, dismissed from his chair in Transylvania. The Medical Faculty was then dissolved and reorganized.[48]

Doctors Cooke and Yandell, and finally Doctor Short, joined Doctor Caldwell to aid in the establishment of the _Louisville Medical Inst.i.tute_. Professors Dudley and Richardson and the a.s.sistant professors, Bush and Peter, remained in Lexington. The celebrated Professor John Eberle was called to the chair of Theory and Practice, but he died shortly after the delivery of his introductory lecture.

Professor Thomas D. Mitch.e.l.l was appointed to the chair of Chemistry, etc., and Doctor James C. Cross to that of the Inst.i.tutes of Medicine.[49]

DOCTOR JOHN ESTEN COOKE

Removed from Virginia in 1827 to fill the chair of the Theory and Practice of Medicine in Transylvania University, which had just been vacated by Doctor Drake. He had already acquired a high reputation as a pract.i.tioner of medicine; he had published an able essay on autumnal fever in the _Medical Recorder_ for 1824, and had in the same year produced the first volume of his very remarkable _Treatise on Pathology and Therapeutics_, the second volume of which he published in Lexington in 1828. The promised third volume, which was to complete the work, never appeared. He remained in Transylvania Medical School until 1837, when, under the leaders.h.i.+p of Doctor Caldwell, he with Doctor Yandell, removed to Louisville to engage in originating a new medical college, the "_Louisville Medical Inst.i.tute_." In this and in its successor, the "_Medical Department of the Louisville University_," he remained until a few years before his death, which occurred on his farm on the Ohio River above Louisville, October 19, 1853, in the seventy-first year of his age.

[Ill.u.s.tration: DOCTOR JOHN ESTEN COOKE.

From a Photograph.]

Doctor Cooke was in many respects a remarkable man, who acquired a widespread reputation in this country, especially in the Mississippi Valley. His fame was mainly built on his celebrated theory of the universal origin of disease, which was, that disease was caused by cold or malaria. That especially it commenced in weakened action of the heart, resulting in _congestion of the vena cava_, its branches and capillary distribution, and that fever was but the reaction of the vital force to overcome this condition, which unrelieved would result in death. According to him, all autumnal and malarial fevers were but variations of one diseased condition, and even those fearful scourges the plague, cholera, yellow fever, dysentery, etc., were simply varied forms and conditions of congestion of the _vena cava_.

To destroy this many-headed hydra--while he would use cold water to reduce too great febrile excitement and even sometimes give antimonial wine[50]--his main reliance was on blood-letting and cholagogue purgatives, as he believed it was by increasing the secretion of the liver and causing it to pour out consistent "black bile" that the venous congestion was to be relieved and the patient cured.

Amongst all these remedies calomel was his chief reliance, and was given by him in doses not measured by the balance but by the effect they produced; so that in the latter days of practice--notably during the epidemic of cholera in Lexington in 1833--he absolutely resorted to tablespoonful doses of this mercurial, repeated _pro re nata_; actually giving about _one pound_ in one day to a young patient, without fatal result.

Two cases may be quoted from his own paper in the _Transylvania Medical Journal_, and from Doctor Yandell's _Memoir of Doctor Cooke_ in the _American Pract.i.tioner_ for July, 1875. "William Dougla.s.s, a student of theology, nineteen years of age, took a tablespoonful (about two ounces) every six hours for three days in succession, having taken the same quant.i.ty the evening before; in all, thirteen tablespoonfuls. He was in collapse when he took the first dose. On the third morning after beginning this treatment his discharges were found to have become thick and green, and Doctor Cooke thought he would have recovered but for the indiscretion of his attendant, who had him to walk across a large room from one bed to another more than once.

Hiccough came on, the patient became delirious, and died on the sixth day. But another patient recovered about this time under similar treatment, and still lives, I believe--a useful Episcopal clergyman, and an ill.u.s.tration of the extent to which calomel may be employed in some diseases without injury to health. Mr. Brittan, a young theological student, took a tablespoonful of calomel soon after having had several copious watery discharges. He was advised to repeat the dose every six hours, until the watery discharges ceased. He took, that day, four and on the next, three of these doses; the discharges not ceasing until some time after the seventh dose had been taken. He took, moreover, three similar doses during the same time--having thrown up three. The _repeated doses_ were given immediately after the regular ones were thrown up. Bilious discharges appeared on the evening of the second day, and were kept up by tincture of aloes and occasionally pills of aloes and rhubarb for a week. The patient was somewhat salivated, but recovered. I saw him a number of years afterwards in perfect health."

Doctor Yandell a.s.serts in this memoir that in this "extraordinary practice, Doctor Cooke was not less successful in the treatment of cholera than his medical brethren in Lexington." But the fact was that none were very successful and that as many as fifty died in a day of a population of a little over six thousand.[51] The writer recollects that Doctor Cooke only practiced in the earlier period of this famous epidemic, having been disabled by a fall in attempting, in his hurry to attend a professional call, to put on his coat while running down stairs.

In another case of cholera which occurred at this time, as the present writer was informed by the intelligent and truthful brother of the young lady patient of Doctor Cooke, these large tablespoonful doses pa.s.sed through the bowels apparently unchanged, being discharged in lumps as large as pullets' eggs, without being even dissolved. This patient did not recover.

Calomel is well known to be practically insoluble in pure water at the common temperature. It is decomposed to a certain extent by the action of light, or by a moderate heat in the presence of water, and especially by the aid of acids of various kinds, and by certain salts such as alkaline and other soluble chlorides--especially pota.s.sium, sodium, and ammonium chlorides.

In all these cases of partial decomposition some of the mercurous chloride--the calomel--is changed into soluble mercuric chloride and metallic mercury. This decomposition is supposed to result from the action of the alkaline chlorides and the chloro-hydric and other acids of the gastric juice when calomel is taken into the stomach under ordinary circ.u.mstances. It is believed that the activity of the calomel depends mainly on the amount of this decomposition which takes place in the body.

Especially does this partial decomposition of calomel into corrosive sublimate occur, to a great extent, when it is mixed in water with sal-ammoniac (ammonium chloride), as has been experienced in cases of poisoning by the administration of even moderate doses of calomel which had been mixed with this salt. In an experiment by the present writer in which three tenths of a gram of calomel and one and two tenths of a gram of sal-ammoniac with ten grams of water were allowed to react at the common temperature for twenty-four hours, as much as 0.019 of a gram of corrosive sublimate was found.

No doubt these facts throw much light on the very irregular action of calomel in different persons and under various conditions, in doses which may be very small or very large. We can easily understand how, when the stomach secretes no gastric juice and when the salts of the blood have been greatly reduced in quant.i.ty by watery purging as in cholera, the calomel may pa.s.s through the alimentary ca.n.a.l unchanged, insoluble and inactive, or exert a doubtful topical action only.

The present writer's own experience--when he was a medical student, and when fully impressed by the sincere and logical teachings of Doctor Cooke, who, however halting and hesitating may have been his manner or unadorned his style of lecturing, always commanded the fixed attention and highest respect of his pupils--soon opened his eyes to the faults in the theory of the professor.

On one occasion, having been brought into a somewhat febrile condition by fatigue in a botanical excursion in hot weather, and having full faith in the statements of Doctor Cooke to the effect that calomel was of all antifebrile remedies the best, and that while a small dose of calomel might prove irritating _a good large dose_ "would sometimes act like an opiate," he took a one drachm dose in full confidence. But instead of the soothing, curative effect he had been led to expect, vomiting and severe irritation of the stomach resulted, so much so that no food but boiled milk could be tolerated for a week or so afterward. Shaken in his faith by his first experience, but not yet convinced of the error of the doctrine of his respected preceptor, the second trial of a drachm dose on a similar occasion completely satisfied him that something wrong had crept into the theory and practice of the honored professor.

Doctor Cooke's only fear in his heroic use of calomel was that it would salivate. But for this untoward influence, he said, one might do almost anything with it. That this substance which, in cases of cholera, he administered so largely with no signs of irritation or salivation, until the patient was in a convalescent state, should sometimes in much smaller doses prove an irritant poison, he did not understand. A quotation from Doctor Yandell's _Memoir_, Page 7, ill.u.s.trates this: "In some cases of fever Doctor Cooke administered a drachm of calomel at a dose, and repeated it until the patient had taken in twenty-four hours as much as two hundred and forty grains. A young lady was thus treated in 1826. After this quant.i.ty had been given she seemed much relieved, but to avert the danger of salivation he thought it prudent to administer jalap and cream of tartar. At night they were thrown up, without producing any purgative effect. She then took a drachm of calomel, and repeated it until she had taken five doses in the course of the night and morning, with the same fine effect in producing abundant bilious discharges, and a remarkably good effect on the symptoms generally." Still uneasy about ptyalism, he gave her cream of tartar all day, but at night it was thrown up as before, without moving the bowels. "My fears of the consequence of giving the only medicine which offered any prospect of saving her," he adds, "held my hand, and she continued to vomit till death relieved her. I reproached myself on her account afterward, and felt conscious that fear of a remote and uncertain evil had induced me to stand and see her die without doing all I might have done. I was convinced she would not have died had the calomel been continued."

After she had thus taken more than an ounce of calomel he honestly believed that he had not given her enough of this medicine! Entirely ignoring the action of the cream of tartar in bringing this substance partly into the condition of a soluble irritant poison!

To convince myself of this decomposing action of cream of tartar on calomel, I placed about a drachm of calomel in each of two small beaker gla.s.ses. In the one I put pure distilled water, in the other I added to the water about a drachm of cream of tartar. Heating them to about blood heat and allowing them to stand for a few hours, I filtered both liquids from the undissolved calomel. Ammonium sulphide, added to the filtered fluids, threw down from that which contained the cream of tartar a sensible amount of dark mercurial sulphide, while that which contained pure water gave no notable reaction. Evidently the cream of tartar had caused the decomposition of some of the insoluble calomel and had produced a soluble mercurial compound. All soluble compounds of mercury are active poisons in small doses, while, as was fully proven by Doctor Cooke's extraordinary practice with this substance, pure unchanged calomel is one of the most insoluble substances. Consequently it sometimes proved harmless in very large doses, as was the case when the copious watery discharges of cholera had removed most of the salts of the blood.

The Doctor took no note of possible agencies which might make his master remedy occasionally poisonous, and scouted the careful practice of some of the older physicians in causing their patients to abstain from the use of common salt while taking calomel, a recommendation based upon valid experience, no doubt, which science has verified.

The Doctor rose to two ounces, or tablespoonful doses, during the prevalence of Asiatic cholera in Lexington, but he did not confine this treatment to that fearful disease. The present writer has preserved one of the last of his mammoth doses--one of a dozen of the same weight (about an ounce)--which he prescribed for a medical student of the session of 1836-37, the subject of pneumonia, and who took eleven such doses in regular succession before he died.

In Doctor Cooke's earlier practice, and in the treatment of less severe cases, he relied greatly on his famous pills--well known in the region of Lexington as "Cooke's Pills"--composed of equal parts of calomel, aloes, and rhubarb; or on tincture of aloes and the lancet, with the occasional use of a few other remedies. These const.i.tuted his sole armament with which to encounter disease. For he was a man of the strictest and most earnest honesty, sincerity, and zeal, and withal so wedded to his logical convictions that he would at any time have died a martyr to his well-matured beliefs. Indeed, according to the testimony of his friend, the late Lunsford P. Yandell, he seems thus to have been to some extent a martyr to his own theory and practice.

On Page 22 of Doctor Yandell's _Memoir of Doctor Cooke_, we are informed that "his practice on himself was of the same heroic character that he pursued with his patients. He bled himself at once copiously and repeated the operation again and again as symptoms appeared to him to demand it, at the same time keeping up purgation with calomel. Exposed as he was on his farm, these attacks became frequent and his const.i.tution, naturally enfeebled by increasing years, at length gave way under them."

Again, on Page 27 of the same _Memoir_, Doctor Yandell says: "The perfect sincerity with which he held his opinions was evinced by his carrying out his practice in his own case. On one occasion this was near costing him his life. He was seized with intermittent fever, on his farm near Louisville in the fall of 1844, and for several days took his pills--composed of calomel, rhubarb, and aloes--in the confident belief that they would arrest the disease; but the chills continued to recur with an increasing tendency to congestion until at last his case became alarming. His old friend, General Mercer, of Virginia, who happened to be on a visit to him at the time, called on me and gave me an account of his situation, asking me to visit him.

Doctor Cooke was reluctant to take quinine, but finally consented and was relieved, and afterward, I believe, used the remedy in his practice."

A characteristic anecdote is recorded of him in _Collins' History of Kentucky_. "One Sunday morning, waiting on some of his family to get ready for church--the Methodist church, of which he and they were members--he picked up a discourse by the Reverend Doctor Chapman, then Episcopal clergyman of Lexington. The argument for the Old Church of England attracted his attention. He perused and studied it fully, sent for all the available authorities on the subject; studied them with such effect that at once he changed his communion to the Episcopal Church and was ever after a rigid and zealous pillar to that church, and an industrious student of the writings of the theological fathers."

His logic, on which he based his medical theory and practice, is most elaborately set forth in his only large work, already mentioned--_A Treatise of Pathology and Therapeutics_--and was tersely summed up by a most zealous believer and pupil of his[52] as follows: "If all diseases result from congestion of the _vena cava_, and if calomel is the best and most reliable remedy, what is the use of applying to any other means?"

Because of its simplicity and its apparently logical basis, the system of Doctor Cooke was very attractive to students of medicine. If true--and they could not doubt it--it was a great new discovery of a royal road to medical practice which avoided all the drudgery over pathology, chemistry, the materia medica and therapeutics of the old school. All ordinary diseases were a unit produced by a common cause, and calomel was the princ.i.p.al panacea!

But alas! the logical system of Doctor Cooke, like many other beautiful and well-laid superstructures, failed in this essential thing--_the foundation on which it was raised was not true_.

Logical minds too often willingly lay down or accept a.s.sumptions, or uncertain facts, as axioms, and are satisfied if the deductions from these are logically accurate and perfect. Doctor Cooke, in a slow and laborious way, took infinite pains to build up his logical superstructure. The writer recollects his ill.u.s.tration of logical connections, by means of certain pieces of wood united by strings; and, notwithstanding his unadorned style and slow and hesitating manner, his students--carried away by his well-known truthfulness, sincerity, and earnest zeal, and incapable of judging for themselves of the validity of his premises--accepted his doctrine as a new revelation and were almost unanimously his ardent followers until experience or more ample knowledge opened their eyes to its faults.

Before he removed from Transylvania School to the new one in Louisville in 1837, severe criticisms of his teachings had been published. Indeed it had begun to be believed by some that these teachings were marring the prosperity of that old college. Soon after his removal to Louisville, we are told by Doctor Yandell, "the current which from the first had set in against his theory and practice grew every year more formidable" until "a.s.sailed on all sides, and from within as well as from without, his theory steadily lost ground, his practice grew more unpopular and his influence as a teacher visibly declined from the day he began to lecture in Louisville."[53] So that in 1843 he was, on pet.i.tion of the students, retired on a three years'

pension of two thousand dollars per annum.

Besides the two volumes of his _Pathology and Therapeutics_ he published a small work on _Autumnal Diseases_, and a number of medical papers in _The Transylvania Journal of Medicine_, of which he was one of the original editors. The congestive theory of disease had its short day, like many others which have floated like bubbles on the stream of medical progress. We remember it as one of the curiosities of medical literature.[54]

DOCTOR CHARLES WILKINS SHORT

Was born in Woodford County, Kentucky, at "Greenfields," October 6, 1794. He connected himself with the Medical Department of Transylvania University in 1825. He had been called by the Trustees in a previous year to the chair of Materia Medica and Medical Botany, but did not at once accept.

Doctor Short was a most upright, conscientious, modest, undemonstrative gentleman of great delicacy of feeling. He was a most zealous and industrious botanist, and was possessed of artistic tastes and ability.

One of his greatest pleasures was in his extensive herbarium, rich with the native plants of Kentucky collected by himself, as well as with those from other regions obtained by the exchange of specimens with the various botanists of the world, with whom he corresponded individually and extensively. He, in conjunction with Professors H. H.

Eaton, H. A. Griswold, and R. Peter, contributed to the _Transylvania Journal of Medicine_ several papers on the plants of Kentucky,[55] and wrote for that periodical several papers on this subject and on medical topics, as well as numerous obituary notices of medical men.

He was not the author of any large treatise.

In addition to his notices and catalogues of Kentucky plants he published in the _Transylvania Medical Journal_:

"Instructions for Gathering and Preservation of Plants in Herbaria."