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TENNESSEE STATE
MEDICAL SOCIETY,
AT THEIR
TWENTY-FOURTH ANNUAL SESSION,
Convened at Nashville, Mav 4. 1853,
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TRANSACTIONS
OP THE
TENNESSEE STATE
MEDICAL SOCIETY,
AT TEEIE
TWENTY-FOURTH ANNUAL SESSION,
Convened at Nashville, May 4, 1853,
NASnmyLi:
PRINTED AND PUBLISHED FOR THE SOCIETY, BY j. F. MORGAN,
No. 50, Cherry Street, 3 doors south of Deaderick.
1853.
TRANSACTIONS
of the
TWENTY-FOURTH ANNUAL SESSION
of the
Ccimeme Ufate fjjejfrfcal Ibrietg.
Nashville, May 4, 1853.
The Medical Society of the State of Tennessee met this day in the
Medical College. Dr. J. M. Watson took the chair and called the
Society to order, and requested the members to register their names ;
whereupon the following gentlemen came forward, viz :
Dr. Felix Robertson,
Dr. A. H. Buchanan,
Dr. John P. Ford,
Dr. Wm. P. Jones,
Dr. R. M. Porter,
Dr. W. H. Morgan,
Dr. R. 0. Currey,
Dr. Robert Martin,
Dr. W. K. Bowling,
Dr. J. M. Watson,
Dr. J. W. King,
Dr. Thomas Lipscomb,
Dr. J. L. Park,
Dr. R. S. Wendell,
Nashville.
Shelbyville.
Franklin.
Murfreesboro.
On motion of Dr. Buchanan, the rule requiring proposals for mem¬
bership to lie over one day, was suspended, when the following gen¬
tlemen were proposed and duly elected members of the Society, viz :
Drs. R. C. Foster, J. D. Winston, T. L. Maddin, P. S. Wood-
4
TRANSACTIONS OF THE TENNESSEE
ward, J. S. Duval, of Nashville; J. M. Larkin, of Charlotte, and
J. H. Morgan and Wra. McNelly, of Bedford county.
On motion of Dr. Wendell, Dr. W. P. Jones was appointed Treas¬
urer pro tern., in the absence of the Treasurer, Dr. Abernathy.
On motion of Dr. Buchanan, the proceedings of last meeting were
read and adopted.
On motion of Dr. Wendell, the order of business observed at the
last meeting was continued for the present session. The President,
Dr. Watson, then proceeded to read the usual address.
On motion of Dr. Jones, the address was received and laid over for
subsequent discussion.
On motion of Dr. Wendell, the Society adjourned to meet at B
o'clock, at the City Hall.
AFTERNOON SESSION.
The President, Dr. Watson, in the Chair.
The following gentlemen were proposed, and duly elected members
of the Society, Drs. Wm. McCombs, J. W. Cray, of Nashville ; J.
C. Patterson, of Davidson county, and R. F. Evans, of Shelbyville.
The following members appeared and took their seats, viz : Drs. B.
W. A vent, of Mnrfreesboro, and M. Ransom, of Rutherford county.
Dr. Wendell moved that the Society next proceed to the election
of officers for the next two years—adopted.
Dr. Lipscomb moved that a committee of five be appointed by the
President to nominate officers—adopted.
The following gentlemen were appointed : Drs. Lipscomb, Avent,
Buchanan, Ford and Martin, who, after consultation, reported to
the Society the names of the following gentlemen, as officers for the
next two years, viz :
Dr. Felix Robertson, of Nashville, President.
Dr. E. B. Haskins, of Clarksville, Vice President.
Dr. John W. King, of Nashville, Recording Secretary.
Dr. R. C. Foster, of Nashville, Corresponding Secretary.
Dr. W. P. J ones, of Nashville, Treasurer.
On motion of Dr. Currey, the report of the committee was received
and adopted.
The Society then proceeded to the regular order of business—the
first in order being the Report of the Committee on the "History of
Continued Fevers of Tennessee." The Chairman, Dr. W. P. Jones
state medical society.
5
submitted a report showing the progress made by the committee, and
requested further time. Committee continued.
Committee on the " History of Surgery of Tennessee." The Chair¬
man, Dr. Avent, reported progress, and desired further time. Com¬
mittee continued.
Committee on " Obstetric Surgery of Tennessee," Dr. Watson
Chairman. Committee not prepared to report.
Committee on " Adulteration of Drugs, Medicines, Chemicals, &c.,"
Dr. Currey Chairman. Deport read and received.
On motion, the Society adjourned to meet at 10 o'clock, to-morrow
morning.
thursday morning, may 5.
Dr. Robertson President, in the chair.
Minutes called for and read.
Dr. E. B. Haskins appeared and took his seat.
On motion of Dr. Haskins, Dr. H. M. Whitaker, of Montgomery
county, was elected a member of this Society..
Drs. Briggs and McGavock, of Nashville, were proposed by Dr.
Porter, and duly elected members of the Society.
The Report of the Treasurer was next called for and read, and on
motion received, and the present Treasurer authorized to audit and
settle claims against the Society.
It is as follows :
treasurer's report.
Balance in hand at last report, April 3, 1851, $31,00
Received from members in contribution fees, at
Session of 1851, 18,00
Paid Telegraph for printing proceedings of
session of 1851, $65,00
Paid same for advertising, 1852, 1,50
Paid Murfreesboro News for advertising, 1852, 1,50
Paid Nashville Union for advertising, 1852, 2,00
Paid True Whig for advertising, 1852, 2,00
Paid for new Secretary's book, 4,50
Paid for Treasurer's book, 20
Paid Secretary's official mail expenses, 45
-$115,00
1,15
Balance in hand, May 3, 1853, $31,85
J. J. ABERNATHY,
Treasurer.
6
transactions of the tennessee
Account of the True Whig office presented and ordered to be paid.
report of cases.
Drs. Bowlin, Knight, Robison, Fain, Woods, Baskett, Wheeler,
Alsup and Morgan, appointed to report cases, not present. Dr. Park,
in lieu of a case, submitted, for the inspection of members, a set of
instruments of his own invention, for the performance of the opera¬
tion of " Fistula in AnoReceived.
Dr. Ransom read a report of an interesting case of paralysis,
marked by several remarkable phenomena. After an animated dis¬
cussion of the points involved in the pathology and treatment of the
case, by Drs. Haskins, R. Martin, Maddin, Watson and others, the
report was received.
Dr. Watson read the report of a case furnished by Dr. Smith Bow¬
lin, of Bedford, on Fallopian Pregnancy. Report received. Drs.
R. Martin, Avent and others, related several of a similar character,
presenting points of much interest, and on motion, were requested to
furnish a full history of the several cases referred to by them, to be
incorporated in the proceedings of this meeting.
On motion of Dr. Maddin, Dr. R. Martin was appointed chairman
of a committee to collect and arrange all the statistical information
bearing on the subject of Extra Uterine Pregnancy, to be presented
to the next meeting of the Medical Society.
Dr. Knight reported a case of gun shot injury of the leg, result¬
ing in a chronic tumor, complicated with hemorrhage. After an in¬
teresting discussion as to the aneurismal character of the tumor, the
report was received.
Dr. B. Wood, Nashville, and Dr. E. C. Robb, Nashville, were
then proposed and admitted as members of this Society.
On motion, adjourned to o'clock.
afternoon session.
The President, Dr. Robertson, in the chair.
On motion of Dr. Avent, it was
Resolved, That a Committee of three be appointed to examine into
the Constitution and By-Laws of this Society, and to recommend
such amendments for its future action as may be necessary ; and
that they be required to report at the next annual meeting.
Whereupon, the President appointed Drs. Buchanan, Rob't Mar¬
tin, and J. P. Ford.
STATE MEDICAL SOCIETY.
*1
Drs. Wheeler and McKnight, of Murfreesboro, appeared and en¬
rolled their names.
The report on the Epidemic Diseases of Tennessee being called for?
Dr. Haskins reported, and asked a continuance till pext session,
which was granted.
Dr. R. C. Foster moved that a committee be appointed to memori¬
alize the Legislature, at its next session, in reference to the manufac¬
ture and sale of quack medicines, and secret nostrums, so as to secure
the passage of a law requiring the recipe of all such to be filed, to
which Dr. Haskins proposed the following amendment:
That this Committee confer with the East and West Tennessee So¬
cieties in reference to this subject, and secure their co-operation ; and
that they report progress to this Society, at its adjourned meeting in
November.
The resolution with the amendment being adopted, Dr. R. C. Fos¬
ter, Dr. Lipscomb, and Dr. Whitaker were appointed on the com¬
mittee.
Dr. Wheeler, of Murfreesboro, offered the following tribute to the
memory of Dr. W. A. Smith of Rutherford, a member of the Society,
which being read, was adopted, and ordered to be spread upon the
minutes of the Society :
Since the last regular meeting of this Society, Dr. W. A. Smith,
of Rutherford county, one of its acting members, has been removed
by death. Though but recently associated with us, he gave evidence
of an earnest devotion to our common profession, and of a willingness
and ability to labor as a member of this Society, which, with sterling
personal qualities, elevated him to a high position in our esteem.
Therefore
Resolved, That, in the death of Dr. Smith, our association has lost a
valuable and worthy member, our profession.a true ornament, society
a most useful and respected citizen.
Resolved, That we deeply sympathize with the family and friends of
the deceased, in their peculiarly distressing bereavement, and we ten¬
der them our sincere and unaffected condolence.
Resolved, That a copy of these resolutions be spread upon our
records and published with the proceedings of this meeting.
Resolved, That a copy be also transmitted to the family of the
deceased.
On motion of Dr. Lipscomb,
Resolved, That it be the duty of the Corresponding Secretary of
this Society to address a brief circular to as many of the respectable
8
TRANSACTIONS OF THE TENNESSEE
members of the medical profession of the State as practicable, a short
time previous to the annual session, notifying them of the time of
meeting, and inviting their attendance and cordial co-operation.
Which was adopted.
On motion it was ordered that the code of Ethics be published
with the proceedings of the Society.
The following subjects were submitted to special committees, to re¬
port thereon at the next annual session.
1. On the Medical Literature of the State of Tennessee.
2. On the Medical Botany of Tennessee.
3. On the Medical Biography of Tennessee.
Whereupon the President appointed Dr. D. W. Yandell chairman
of the first committee, Dr. Richard 0. Carrey of the second, and Dr.
W. K. Bowling, of the third.
Dr. E. B. Haskins offered the following :
Resolved, that a committee of three be appointed to prepare a me¬
morial to be presented to the next Legislative Assembly of the State
of Tennessee, asking the passage of a law for the registration of births,
marriages and deaths, and to frame the outlines of such a law as
may seem best suited to the political organization of our State, and
report to an adjourned meeting in November, and that Dr. J. P. Pord,
of Nashville, be appointed Chairman of said committee. Adopted.
On motion of Dr. D. W. Yandell, it was
Resolved, That a committee of three be appointed to prepare and
submit, at the adjourned meeting of the society, a Case Book : which
being adopted, the President appointed Drs. D. W. Yandell, R. C.
K. Martin and J. D. Winston, on said committee.
It was moved, seconded and adopted, that the Treasurer of this
Society address each member who has not attended this meeting,
and request the immediate payment of the annual fee.
It was moved that a committee of three be appointed to superin¬
tend the pnblication of the Minutes of the present meeting, and that
five hundred copies be printed, of which fifty copies to be retained in
the hands of the Secretary. Adopted.
On motion of Dr. Jones, the fines levied against Dr. J. W. King,
for failing to comply with the duties of Orator and Reporter, were
remitted.
On motion of Dr. J. W. King, it was
Resolved, That, in order to give strength and efficiency to the
State Society, it is indispensable to have the co-operation of County
Medical Societies, and to effect this desirable end, we hereby ear-
state medical society.
9
nestly invite and solicit our brethren in the different counties through¬
out the State, to organize themselves into local societies ; and that
the physicians of Davidson county be requested to take the initiative
steps in this movement.
On motion of Dr. Bowling, the names of all the members of this
Society were ordered to be printed in the forthcoming Minutes.
Dr. Buchanan related a case of Injury of the Chest, in which
there was a protrusion of the lung, through a cut dividing a portion
of the Pleura Costalis—and, after eliciting a very interesting discus¬
sion, in which Drs. Buchanan, Bowling, Martin, Haskins and Yan-
dell participated, it was moved by Dr. Haskins, that Dr. Buchanan
prepare a statement of the case for publication in the proceedings of
the Society. Adopted.
Dr. Yandell offered the following Preamble and Resolution :
In order to encourage original research,
jResolved, That a prize of $50 be awarded for the best original,
practical, or experimental medical essay by the members of the So¬
ciety, provided that any of the essays be deemed worthy of said prize.
Said essays to be submitted to and reported upon at the next annual
meeting of the Society.
To which Dr. Wilson, who appeared and took his seat, offered the
following amendment:
And that for the second best essay a prize of $25 be awarded.
All of which were adopted.
Society then adjourned to meet at p. m.
evening session.
Dr. Robertson, President, in the Chair.
The Society was called to order by the President, and Dr. Currey
appointed Secretary pro tem.
On motion of Dr. Avent,
Resolved, That all druggists in Tennessee, who desire the promo¬
tion of medical science, be requested to discontinue the sale of nos¬
trums and quack medicines.
And Resolved, further, that in our purchases of drugs and medi¬
cines, we will prefer such as may adopt this course. Adopted.
Dr. J. J. Abernathy, of Murfreesboro, was continued as Orator
for the next annual session.
10
TRANSACTIONS OF THE TENNESSEE
The President also appointed the following members to report cases,
Dr. Duval, of Nashville.
Woodward,
it
Maddin,
a
Robb,
a
Foster,
a
Wendell,
of
Murfreesboro.
McCullough,
it
Knight,
of
Rutherford county.
Ransom,
it
Park,
of
Franklin.
Evans,
of
Shelbyville.
McDaniel,
of
Clarksville.
Whitaker,
of
Montgomery county.
The Society then adjourned to meet at 10 o'clock on to-morrow.
FRIDAY MORNING, MAY 6.
Dr. Robertson, President, in the Chair.
On motion of Dr. Haskins, it was resolved, that the adjonrned
meeting of the Society be held on the second Wednesday in Novem¬
ber next, in the city of Nashville, at 10 o'clock, A. M.
Dr. Bowling introduced the following resolution, which was adop¬
ted :
Resolved, That the duty of appointing representatives to the Amer¬
ican Medical Association, devolve upon the President of this Society,
and that when such appointments are made, the names of the dele¬
gates be furnished to the Medical Journals for publication.
On motion of Dr. Currey, it was resolved, that the next annual
session of this Society be held in the city of Nashville, on the first
Wednesday in May, 1854.
Dr. Robert Martin offered the following resolution, which was
adopted, and the Secretary instructed to communicate the same :
Resolved, That we tender our thanks to the Mayor and City Coun¬
cil, for the use of the City Hall, during the annual meeting of the
Medical Society of Tennessee.
The Society adjourned to meet on the second Wednesday in No¬
vember next.
state medical society.
11
SPECIAL COMMITTEES.
1. On the History of Continued Fevers in Tennessee, Dr. Wm. P.
Jones, of Nashville.
2. On the History of Surgery in. Tennessee, Dr. B. W. Avent, of
Murfreesboro'.
3. On Obstetric Surgery in Tennessee, Prof. J. M. Watson, of
Nashville.
4. On Epidemic Diseases of Tennnssee, Dr. E. B. Haskins, of
Clarksville.
5. On Medical Botany in Tennessee, Dr. Bichard 0. Currey, of
Nashville.
6. On Statistics of Extra- Uterine Pregnancy, Dr. Robert Martin,
of Nashville.
"I. On the Medical Literature of Tennessee, Dr. D. W. Yandell, of
Nashville.
8. On the Medical Biography of Tennessee, Prof. W. K. Bowling,
of Nashville.
OFFICERS.
Dr. Felix Robertson, Nashville, President.
" E. B., Haskins, Clarksville, Vice President.
" J. W. King, Nashville, Recording Secretary.
" R. C. Foster, Nashville, Corresponding Secretary. :
" W. P_. Jones, Nashville, Treasurer.
STANDING COMMITTEES.
1. On Constitution and By-Laws, Drs. Buchanan, Robt. Martin,
and J. P. Ford.
1. On Memorial in reference to Nostrums, Sfc., Drs. R. C. Foster,
Jiipscomb and Whitaker.
3. On Memorial in reference to registration of Births, Carriages
and Deaths, Dr. J. P. Ford, of Nashville.
4. On Case Book, Drs. Yandell, R. C. K. Martin, and J. D.
Winston.
5. On Publication, Drs. R. Martin, Currey, and McCombs..
ANNUAL ADDRESS
BEFORE THE TENNESSEE STATE MEDICAL SOCIETY,
BY DR. JOHN M. WATSON, PRESIDENT.
The duty of reading an address before this Society again devolves
on me, and without further apology I shall now proceed, only that I
would gladly offer one for the essay itself.
The subject is Medicine—it could be no other: indeed Medicine, in
some shape, must constitute the subject. Its high concerns have
brought us together to-day—will hold us together awhile—nothing
else could. They have been, are now, and will continue upon our
minds, characters and hands. Our past lives have been shaped by
them, our present state is identified with them, and our future pros¬
pects take hold of them. We will have to talk of physic to-day, of
physic to-morrow, and of physic all our lives. What else, of a tem¬
poral nature, should concern a doctor ? Although we cannot live
always by taking or by giving physic, yet it does sometimes confer
earthly immortality upon her votaries ; upon those who have turned
their genius, energies and time, in her way. Medicine has a light, a
scientific light, that can never be extinguished; which reveals and
perpetuates many names, that in all probability, would otherwise
have passed away with the world's nameless dead. Through its
light and power the "inner man" may be preserved; though the
" outer man " perish, he may live, counsel and heal, to the end of
time. A noble science is this indeed, and a no less noble doctor who
can, in that way, put forth his healing hand onward through many
centuries, or perchance through the whole residue of time ! What
if medicine allow the outer man to die ? it finds an apology, even a
christian apology, in the truth that " man is born to die." Though
once endowed with the physiology of life, and possessing capabilities
of living forever, through Eden's therapeutic guaranty, that physiol¬
ogy has, under heaven's curse, been changed into a mortal pathology,
one that will end in death, in despite of all skill and medicine ; it
state medical society.
13
Teigns unto death. This, in its risings and ebbings, may be con¬
trolled or modified greatly by therapeutic agencies, but the death ten¬
dencies of our present physiology can never be eradicated. No
medicine can do that; but even in view of the sentence, "thou shalt
surely die," we can, with our lancet, calomel, etc., greatly aid the
mortal system in righting itself, and enable it to regain its best con¬
dition, and though that be a decline itself, yet it is compatible with
long life.
As before remarked, Medicine must constitute the subject; it may
be best to deal with it in a general way ; we must all say something
on the subject; our minds and feelings cannot be relieved in any oth¬
er way. I will at once propose my subject as follows :—Retrospec¬
tive, Perspective and Prospective Views of Medicine. Each branch
of my subject will give to, and receive strength from, the other. A
retrospect will bring back light on the perspective, while a judicious
perspective will not only give us the present picture, but extend its
outlines even, under prospective lights. A retrospect of Medicine, in
its fullest sense, would involve a complete history of Medicine, but
this is not intended. In looking back into the distant past, many
things must necessarily be overlooked ; prominent objects only can
now engage us. The past gives an uncertain response to the follow¬
ing enquiries : How did Medicine take its rise ? Who was the first
sick man ? What was his disease ? What was done for him ? Alas !
no one can tell. But, according to the history of the pathology of
our nature, we can readily imagine that Medicine arose in the wants
of our nature. We can easily suppose that some inward gas¬
tric burning was felt even by the first man, that gave rise to an
instinctive desire for a cooling draught of water. Friction over the
seat of pain was, doubtless, also instinctively employed. Some arti¬
cles of diet, which had been previously ascertained to be laxative,
were probably employed whenever the bowels became too torpid ;
and when they were too free, articles which had restrained the bow¬
els in health, might have been used to check them in disease.
Agreeable dainties may have been employed to check vomiting, and
simple titillation of the fauces may have suggested itself when the
stomach was overloaded and oppressed. These simple means, we
may readily infer, were multiplied and improved to such an extent as
to be practiced by some particular persons who had become more
skillful in their employment than others, and were consequently
sought after and required to administer them ; in that way doctors,
in all probability, first came into existence. Knowledge of this kind,
14
TRANSACTIONS OF THE TENNESSEE
among the early communities of mankind, became private property ;
hence, among the early Egyptians, medical knowledge was kept se¬
cret among their Priests, and by them practiced to the exclusion of
others. The miraculous healing among the Jews, by faith, through
outward signs and ceremonies, were followed by superstitious practi¬
ces, charms, amulets, &c. The early votaries of Medicine, like those
of other sciences, aspired to a species of theosophy, which was never
realized,: and which often gave rise to gross absurdities.
Even among the early Greeks, while medicine was in its Grecian
infancy,_ JEsculapius, "who was physician to the Argonautic expedi¬
tion, became so famous and successful as a practitioner of medicine,
as to receive divine honors after his death, in the character of the
God of Medicine. If the healing art could, at that early day, secure
deification and divine honors to one of its votaries, may we not infer
that many valuable remedies were then known ? We also learn that
the skill and success of JBsculapius excited much envy and persecu¬
tion, which caused his death. Pluto even complained to Jupiter of
his success, who, in turn, soon hurled the fatal thunderbolt at him.
Thus, we see, he is said to have excited even the jealousy of the Gods
themselves. These things, though obscure and marvellous, speak
well for medicine even at that early period.
Medical knowledge was, among the early Greeks, almost heredi¬
tary ; it descended in a regular way, from father to son, especially
among the order of priests denominated the Asclepiades, to which
order belonged the great Hippocrates ; he, about five hundred years
before Christ, reduced the isolated and irregular truths of medicine
to a scientific form, and in that way became the founder of scientific
medicine, and the originator of medical schools. It is remarkable,
indeed, that the course of Hippocrates, in his day, should have been
so much like that of the leading physicians of our own times—that
of carefully and successfully observing the palpable results of experi¬
ence, in contradistinction to mere theoretical deductions. But I
must now pass on from him, whose researches, observations and sci¬
entific arrangements, deserve volumes of strictures, to the considera¬
tion of other objects now presenting themselvesin the yet distant re¬
trospect.
Yet I must be allowed to state that his system was, in the fullest
sense of the term, "empiric rationalism." Observation, and not
speculative deductions, must be our rule in the treatment of diseases.
Theory cannot be relied on, unless based upon it, and regulated in
toto by it. Empiric rationalism, ( or term it what you may,) consti-
STATE MEDICAL SOCIETY.
15
tutes the successful and reliable system of the present day, and must
continue so as long as the science of medicine lacks perfection. Noth¬
ing but perfection, which we all know cannot be attained, can super¬
cede this system of the old Greek Teacher.
At the great city of Alexandria, 300 years before Christ, medi¬
cine was taught as one of the branches of learning taught at that
place. It is said to have soon degenerated there, and to have taken
on a great variety of forms or systems. Hence we read of the Em¬
piric School, 286 B. C. ; the Methodic School, 100 B. C. ; the
Pneumatic School, 68 B. C., and the Eclectic School, 81 B. C.
Celsus, the Boman Hippocrates, as he has been aptly termed,
gave a Grecian character to Medicine 65 years before Christ.
Amidst all this confusion, the great medical light of Pergamos
arose, A. D. 131, and dispelled much of the medical mists of that day ;
but unfortunately divided the medical world into Galenists and Chem¬
ists, and all drugs into Galenicals and Chemicals. His opposition
to chemical remedies is even yet to be deplored, as hlfe system took
precedence of all others ; every thing connected with chemistry was,
consequently, repudiated by his numerous followers. I may say, that
almost every thing pertaining to the science of medicine in his day,
was thoroughly galenized for many centuries, even down to the six¬
teenth. extending through the middle ages. The different systems
taught diiring that long period, were modifications of the Galenic
system. |The Arabian physicians, in all their boasted culture of med¬
icine, addpted Galenism as the basis of their systems.
Unfortunately the great Physician of Pergamos was opposed to
chemicals, so called in his day, and the warfare between the advo¬
cates of chemicals and non-chemicals, was long and severe ; and,
doubtless, did much to retard both Medicine and chemistry. Though
it should be said, to the credit of this great and strong man in medi¬
cine, that he did more in his day to advance the science of Medicine
than any other person—and had he not been prejudiced against
chemicals, he might have done more.
The star of Medicine arose in Arabia in the person of Avicenna,
who, though, only reflected dimly the light of Grecian knowledge.
The Arabians translated the Greek writers into their own language,
and the science of Medicine, though studied by them, was not im¬
proved.
During the long night of the middle ages, we learn that Medicine,
unfortunately, fell into the hands of the Monks, and was by them
divorced from anatomy, surgery and chemistry ; and, I may add, from
16
TRANSACTIONS OF THE TENNESSEE
common sense itself. Medicine, as a science, suffered in their hands
as did the Christian religion itself. Even man's very nature was per¬
verted by them.
Western lights arose in the ninth century. The Medical School
at Salerno, in the eleventh century, presents, in the distant waste of
our retrospect, a refreshing and agreeable prospect. Here Medicine
was taught on Grecian principles, and may be seen in agreeable re¬
lief amidst the Galeno-Arabian modifications of that day.
The science of Medicine, though for the most part passive, in the
writings of the Greeks, began now to revive and resume its true
Grecian way. Anatomy began to be studied in the fourteenth cen¬
tury, and the name of Mondini is historically identified with its re¬
vival.
About this time a circumstance arose which gave rise to a general
dissemination of Medicine according to Grecian culture. Constanti¬
nople fell into the hands of the Turks in 1453. It was then with
men of science as it was with the early christians under their perse¬
cutions—the latter " went forth preaching every where," so did the
former. By the Turkish conquest, they were driven from Greece^
and disseminated the light of science whither soever they went; be¬
fore which superstitions, prejudices, false theories, &c., gave way in
many places, and even the Galenic system itself had to fall before it.
Up to 1619, the circulation of the blood was unknown ! William
Harvey discovered it in the early part of the seventeenth century.
But the Lymphatic vessels were not discovered until the middle of the
seventeenth century.
Towards the close of the eighteenth century, Dr. Edward Jenner
gave the world an antidote against Small Pox. Medical schools
multiplied in different parts of Europe, and in England distinct
schools for Surgery, Midwifery and Clinical Medicine, became es¬
tablished on a scientific basis never again to be overturned.
The Science of Medicine, with all of its accumulated truths, began
to resolve itself into particular branches ; and though long cultivated
together, Medicine and Surgery began to be regarded as distinct
sciences. As early as Hippocrates, we learn that the physician was
sworn not to perform the operation of lithotomy. The Arabians
thought the physician should not perform operations, that they were
beneath his dignity ! The slaves of the Romans attended to the prac¬
tical part of Surgery, according to the same view of the subject.
The progress of Surgery was greatly retarded by the council of
Tours taking it out of the hands of all others except the Jews and
STATE MEDICAL SOCIETY.
IT
clergy. They were allowed to practice Medicine to the exclusion of
all others. The Council, in its blindness, declared that no bloody
operation should be performed by them. Thus was Surgery even
banished from the universities, under the pretext that the church de¬
tested all bloodshed. This was, indeed, in the fullest sense, straining
at a gnat and swallowing a camel.—A living man might be tortured
to death for a mere difference of opinion about the trifling affairs of
a religion that would not allow the anatomical examination of a dead
one ! It was then that this noble and responsible branch fell into
the hands of bath-men and barbers! When the archbishop Will¬
iam interdicted the beard, in 1096, barbers were brought into imme¬
diate requisition, and strange, indeed, that Surgery, with all its high
qualities, should have remained for several centuries, in such hands J
But dark and long was the eclipse of Medical Science, during the
middle ages.
But the world could not get along well without a better surgery;
nor could it be kept ignorant of human anatomy. And an improve¬
ment in anatomical knowledge could not fail to advance surgery.
Berenganode Carpi, Fallopius andEustachius, could not fail to open
up the way to Ambrose Pare, by which he was able to elevate both
the principles and operations of Surgery far above the hands and
beads of bath-men and barbers !
In 1T31, the Surgical Academy was established in France, and be¬
came celebrated throughout Europe. Distinguised surgeons then
arose in France, in England, in Italy and Germany, and the north of
Europe—names I need not mention—to whose labors, authority and
success, this branch of Medicine owes its high and well established
principles, as well as its splendid and indispensible operations. This
branch is now well defined, and gives free scope to the best minds
and most skilful hands ; and the horror which once attended opera¬
tions has been removed by the ligature and chloroform ! Pain and
bloodshed, to any great extent, no longer attend the operations Of
the skillful surgeon. Not that the surgeon's knife is any sharper, or
the parts less sensitive, but these horrors have been removed by the
triumphs of science.
When we look backward into the distant past, we cannot discern
anything like special midwifery. The necessities for general clinical
medicine and surgery, un man's early state, seem more apparent than
those for obstetrics. The imagination, however, without much effort,
may readily recognize early urgent necessities of this kind, though it
is probable their occurrence was not frequent. The simplicity of
18
TRANSACTIONS OF THE TENNESSEE
the lives of the early races, so consonant with easy and safe parturi¬
tion, must have exempted the child-bearing woman from many diffi¬
culties and dangers to which she is now exposed. Though we have
not the Bible's record of woman's longevity before the flood, like that
of man, yet we must infer that there was some correspondence ; and
if so, her constitution must have been very different from what it
now is.
Midwifery made but little advance until the necessities for its cul¬
tivation increased with the advancement of civilization and its artificial
course. The history of Midwifery among early nations, or even
among present savage tribes, would be very simple, and though the
early women did not have the blessings of this great art, yet they were
exempt from what has been happily termed meddlesome midwifery, and
also from the present urgent necessities for all that the science or art
of obstetrics can afford. It is quite evident that child-bearing, in its
safe and onward way, in the early ages, could not have required the
artificial measures now so often indicated.
The history of parturition among the Egyptians, Jews, Greeks,
Arabians and Romans, shows that necessities have become greater in
modern times. Then it is quite apparent that as woman was artilized
by more modern customs, habits, ease and luxuries, she gradually un¬
derwent changes which subjected her to the necessities that often ur¬
gently demand artificial management of her parturition. Midwifery,
like Surgery, was slow to form itself into a separate branch of medi¬
cine. In early times its dependencies on the general science were too
great to admit of its assuming a more separate or independent form.
The best informed and most skillful physicians were doubtless the
best obstetricians in the early ages. That manual assistance was oc¬
casionally given to both mother and child in early times, I have no
doubt; and those employed in performing these offices were termed
midwives. The sufferings of the parturient women were well calcu¬
lated to call her relatives and friends around her ; and as the term
" obstetrics " is derived from the verb obsto, to stand near, or anti and
ismai, to stand against, we infer that this great science began in those
early attentions which seem to have been instinctively indicated and
fulfilled.
Scientific Midwifery took its rise among the Greeks, about the mid¬
dle of the fourth century before Christ. Some say that the Greeks
had a better knowledge of Midwifery at that day, than the Europe¬
ans during the last century. Thus we see that more has been done for
this useful science during a short time past than was done during
STATE MEDICAL SOCIETY.
19
many centuries before. Locamus and Moschion were the earliest
writers. They wrote about the conclusion of the first century after
the birth of Christ.
In the middle ages, this science like all others, was very much neg¬
lected. It remained long in the hands of the monks, merged into
general clinical medicine, having scarcely any separate existence, as
did surgery also. It also remained long in the hands of women, ig¬
norant of all those things which have since constituted it a science
and an art. The Popes, in those days, interdicted surgery and anat¬
omy. Thus was Midwifery, with all of its capabilities of constituting
a n,oble branch of Medicine, long retarded in its advancement by the
injudicious course of the Popes, who not only embarrassed and hin¬
dered the advancement of this science, but that of all others also.
It may be truthfully said, indeed, that they brought darkness, yea,
gross darkness, over the whole face of the earth. Scientific, moral
and religious lights were all nearly extinguished by them. And but
for him who, in the conclusion of those dark ages, said " Let there
be light, and there was light," what would have become of the world!
Moral, scientific, and religious lights arose in many parts of the world.
A reformation in religion brought along with it a reformation of mo¬
rals and of pursuits ; and great, indeed, were the results. "Except the
Lord of" Sabaoth had left us a remnant, we would have been yet like
unto Anti-Christ."
This elect remnant consisted of such as Arnold of Brecia, the
Waldenses, Wickliff, Huss, Luther, Calvin, &c. Through these, as
chosen instruments, did the world cast off its darkness, its thraldom,
and superstitions. Man's way on earth had been strangely perverted.
Gross darkness had settled over it ; but the thirteenth century
brought relief, in degree, at least. Under its lights, great was the
reformation in all things. How many inglorious ASsclepiades, Galens,
Avioennas, and Modinis may have passed away unknown and unde¬
veloped amidst the darkness of the middle ages, none of us can tell.
Midwifery, like other sciences, has its eras. The establishment of
obstetrics in schools constitutes one'. The discovery of the forceps
another ; then comes the epoch of the emmenagogue powers of the
ergot, and lastly the discovery and application of Chloroform in ob¬
stetrics.
The names of Chamberlain, Starnes and Simpson need scarcely be
mentioned in connection with these discoveries, as they are so clearly
and inseparably identified with them.
20
TRANSACTIONS OF THE TENNESSEE
What would Midwifery as a science or art be now without her ob¬
stetric anatomy, physiology and pathology—without her established
principles, her forceps, ergot and chloroform ? With these, it may
be called a science and an art, without them, there would be no use¬
ful obstetrics.
In our retrospect, we must not fail to look at the use and progress
of another collateral branch of Medicine—one from whiehmany reme¬
dies are derived.
In the beginning of the world's great reformation, chemistry was
in its alchemy—in its dark beginnings ; but the great Hermetic art
was destined, from its own elements, to advance, and become a great
science. The enthusiast Paracelsus saw much in it that he could not
define, and vainly attempted a chemico-theosophy. Chemistry, as we
have already seen, soon triumphed over Galenism ; and to it we as¬
cribe, very properly, the discovery of many of our most valuable
mineral remedies, and a happy modification of our vegetable thera¬
peutics. But unfortunately too much was expected from chemistry at
an early day ; more than can be realized in our present mortal state.
Nothing now known, nor anything else pertinents ad mundum, can heal
the connate pathology of our nature, nor need we ever expect from
any of the branches of Medicine a remedy for our natural infirm¬
ity, or the means of sustaining the prime of manhood or womanhood,
or of repelling decline and death. These are so fixed in our nature
that they will ever work to their pre-ordained issues. The lapis phi•
losopkorurtt', the dixir of life, and the adepts thereof, are ideal views,
not to be realized during the present state of man or of the world.
Even the ancients saw that great things might be developed by
Chemistry, and evidenced the same by conferring divine honors on
Hermes Trismegistus the founder of alchemy. He was placed among
the gods, as was Esculapius. He was supposed to have opened a
fountain of secret wisdom, as he really did, but its mysteries were not
to be solved in an age, nor in many ; for, indeed, the last century of
the world's existence may give rise to more splendid discoveries in
this icience than others before. Hermes Geber, the Arabian Lullius,
Boger Bacon, and Bassilius saw much in this science that they could
not understand, but arranged many things for the hands of others.
These men in our day would have been Lavoisirs, Davys, Brandts,
Liebigs and Faradays.
Chemistry, in its present state, has, like midwifery and surgery,
become inseparably connected with Medicine. It cannot be dis¬
pensed with. We had just as well renounce calomel, the mineral
rT
state medical society.
21
salts, and our rich vegetable products in their fine chemical modifica¬
tions. Surgery, though in many respects a separate branch, is yet
dependent on clinical Medicine for some of her special principles
and therapeutics. Surgery derives great advantage from chloroform
and opium, and has often to resort to the common principles of medi¬
cine. These branches are mutually dependent on each other, and
yet maintain an independent and separate state in a qualified sense.
Nor should I pass over in silence the basis of clinical medicine,
Materia Medica, and that of anatomy as the basis of surgery espe¬
cially, and also of clinical medicine and midwifery. In our retrospect,
we see that these different and great branches have been well cultiva¬
ted of late—also that there is no hinderance now, as formerly, to the
prosecution of the study of any of them, Nor are they trammeled
and governed by theory and men's opinions, as formerly, but by sci¬
entific discoveries, and reliable practical truths derived from them,
and the observations of experience.
In our hasty retrospect we see that the great arbor medica is of early
growth ; that it was secretly cultivated by the Egyptians, more skill¬
fully and scientifically by the Greeks, and to them yielded its early
fruits; that it was rudely uprooted from that congenial soil and
transplanted in Arabia, where its leaf faded, and its fruit degenerated;
from thence it was removed, some say to one place, and some to an¬
other ; but be that as it may, we are sure that a branch from the pa¬
rent stock has been planted in our own America, which took deep
root, and has grown up into a noble trunk, with majestic branches
that shed their leaves constantly for the healing of the curable mala¬
dies of the nation.
The second proposition now comes up—A Perspective Yiew op
Medicine.—Medicine as it now is, collectively, in all its different
branches.
The picture must be seen in perspective—its lights must be well ar¬
ranged and the distance of observation well regulated. The first
consideration is, what shall we do with its quackery, its imperfections,
uncertainties, and its mal-administrations ? These must be carefully
worked off into the back-ground of our picture. Quackery will
afford the plumbum nigrum for shading. These shadings will only
present our picture in clearer relief. Astronomy, it must be recollec¬
ted, had its astrology, chemistry its alchemy, philosophy its super¬
stition, and even Divinity its heresy ; and why should medicine not
have its quackery ? ' The scientificlight off astronomy dispelled its
incumbent mists of astrology ; philosophy, in the same way, expo-
22
TRANSACTIONS OF THE TENNESSEE
sed its attendant superstitions ; and the light of the science of chemis¬
try became too clear and strong for the practices of alchemy. And
I may add, that divine light has exposed and brought many hurtful
heresies to an end. Then why should quackery prevail ? We reply,
because it evades the light of science. Many "love darkness more
than light," and because the deeds of quackery are evil, its votaries
will not come to the light, lest their deeds be reproved. Quackery
is emphatically antagonistic to medical science. Let us see if it be
not so. We will take any quack remedy or nostrum in hand, and
prove our proposition by it. Look at it; its scientific name has been
suppressed, its therapeutic qualities concealed, its color, smell and
sensible qualities disguised, sometimes to such an extent as to defy
scientific detection, and the article is thus brought from the light of
science into the gross darkness of quackery.
The evil way of the quack may be regarded as a way of darkness,
of knavish practices, and of hurt to communities. Suppose that this
nostrum was brought under the light of medical science, so that its
true name could be known, along with its proper therapeutic quali¬
ties, and the general indications which it might fulfil—its virtues as a
quack nostrum, would be at once nullified. Who would pay dou¬
ble, trible, or quadruple, for calomel, corrosive sublimate, arsenic
or quinine, thus barlariztd, if I may be allowed the term. As as¬
tronomy has left its astrology to the lowest minds, as well as philoso¬
phy its superstition, so must Medicine dispose of its quackery. But
as long as astrology, superstition, alchemy and heresy afforded a
prospect of gain, they were maintained ; and so it will be with quack¬
ery ; as long as its practice is lucrative, it will continue, vile as it is.
Then we look to the light of science for relief on the one hand, and
to a reformation of morals on the other. At present, it is in our
mi,dst, and will not come to the light. There is something wrong in
the getting up of those articles which are not so fully drawn from sci¬
entific light, such, for instance, as the cherry'pectoral, liverwort and
tar, and the like. Thus has the vain-attempt been often made to
send forth medicine without the doctor. TEJie doctor must always go
with the remedy, unless we really could obtain an elixir of life, or pa¬
nacea for all complaints, in all climates, of- all ages, sexes and condi¬
tions of life. Medicine, to do good, must be skilfully administered.
Mind and Medicine cannot be safely divorced, and the curse of quack¬
ery is engendered by so doing. The quack does not like to adminis¬
ter his own nostrums—he will not go along with them—he knows too
well the cheat he is practicing on his dupes. But scientific Medicine
STATE MEDICAL SOCIETY.
23
and the doctor must go together ; they twain must become one in
scientific wedlock, and what the wisdom of ages and the light of sci¬
ence have joined together, let no quack put asunder. We had as
well separate the pilot and the ship, the surgeon and the knife, as the
doctor and the medicine. This has, indeed, been a fruitful source of
quackery. The getting up of something that would afford great gain,
and would be employed without the presence of the doctor.
But enough of quackery now—in our prospective view of medi¬
cine, we shall see it give up the ghost, as did astrology, alchemy, su¬
perstition and many heresies. We will now bring forward, on the
back-ground of our picture, lighter shades than the foregoing :
The uncertainties of Medicine. These must be looked at under
proper lights and at proper distances, according to the best rules of
perspective, or we shall be deceived by them, and their shadowing
become too dark or too light. We must maintain the perspective
of color at least. After all our general advancement and special
improvements, Medicine is still an uncertain science. Its uncertain¬
ties may be lessened, but never entirely removed. All sciences have,
of necessity, their imperfections and consequent uncertainties. We
have no right to expect a perfection of medical science beyond that
of healing the diseases of man, so as to enable him slowly to exhaust
the vis vitce of his mortality, and not die in any of its acute forms.
This is all that the healing art can ever accomplish. The uncertain¬
ties now under consideration, are not well understood, either by the
profession or the people. A physician bleeds one patient, and he is
relieved like a charm by it; he again bleeds another, who sinks un¬
der it. Friends exclaim, and the doctor feels, the uncertainty of the
means. Observe, the uncertainty was not in the venesection itself,
but in the practitioner who employed it. The first patient required a
bleeding, the second did not—one was cured and the other injured.
Thus we see that one doctor will cure his patients by the very means
with which another will injure or destroy them. Again, a physician
may, in view of careful observers, bleed his patients so well, accor¬
ding to proper indications, as to cause them to regard venesection as
a certain remedy ; while another may bleed so indiscriminately as to
occasion other good observers to condemn the operation as a very
uncertain means. Besides, the inflammatory disease may have set in
so violently, or have taken such deep hold as to be beyond the pow¬
ers of such a remedy ; its uncertainty, in such a case, would be due to
the remedy itself, and not to the physician. Further, one physician,
by the skillful employment of his lancet, calomel, tartar, etc., cures
24
TRANSACTIONS OF THE TENNESSEE
all, or nearly all, his patients, and a whole community is impressed
with the great certainty of his means ; while another doctor with the
same in hand, loses nearly all his, and many cry out against his
remedies, and denounce them as unreliable. We should never be sat¬
isfied with our treatment of disease, unless we can, from an impartial
view of the case, trace the uncertainty or failure of our remedies to
the uncontrollable powers of the disease itself, as is, alas, too often
the case. Mind, experience and medicine, must go together. The
healing art must be properly represented. Great minds have always
advanced the science, and removed many of its uncertainties. Had
Bacon, Newton, Locke and Herschell, devoted themselves to Medi¬
cine, they would have improved it; for although it requires some pe¬
culiarities of intellect, yet any great mind can represent it and dis¬
seminate its blessings ; but it cannot have a full and fair representa¬
tion through weak minds. It must have intellectual light, or grope
its way in darkness and uncertainty.
Cullen's calomel, bark, nitre and antimony, were no better than
those of his cotemporaries ; yet they were much more certain in their
effects, because the intellectual light under which they were admin¬
istered was clearer and stronger. Rush's lancet cut no better than
those of his associates, but far more good was done by it. The
cause is plain. He had become an adept in the diagnostic signs for
its employment. And those great men who have become adepts in
the use of our principal remedies, have learned their indications
so well, and employed them so skillfully and constantly, that they
have been charged often with entertaining them as hobbies ; but
it is not so. They had learned to give these remedies in the light of
science and experience, until they could administer them with far
more certainty than others in whose hands they were uncertain
means, and consequently were regarded as mere hobbies. Bark was
no hobby with Cullen, nor the lancet with Rush ; I would as soon re¬
gard the scalpel of Bell, or the gorget of Dudley as hobbies with
them. They became surgical adepts in the employment of these in¬
struments, and by their skill in the use of them, took the lead of
others in the certainty of success. In short, we may say it is so with
all the means of the healing art.
Thus means partake pretty much of the skill and knowledge of
the hand that employs them. We lay great strength, indeed, on the
acquisition of new remedies, and on an improvement of those now
known—even a good remedy becomes stale and neglected in that
way ; but should we not rather reg ard the improvement of doctors
STATE MEDICAL SOCIETY.
25
with more concern than we do, knowing that it is only by their
knowledge and skill, that our present available means can produce
their best beneficial effects. Then the doctors must be improved, as
well as our medicines, since we see that they succeed so signally in
the hands of some, and fail equally as much so in the hands of others.
So, the fault is not so much in the remedies as in their administra¬
tion ; failures of this kind cannot always be ascribed to a difference
in cases, though it may sometimes depend upon the like. But I will
here remark that I have no charge to make against the physicians
of our country. I will not accuse them of a want of skill, for I be¬
lieve the profession, in a general way, is well represented in our
country ; though western physicians have not, generally, sufficient
time for reading, study and writing. They are, by their constant
employment, hindered from doing so. The intellectual, observing
doctor, will improve by every case he has, and still more by every
book he reads.
There is another reproach to the profession, which can only be
drawn with the plumhm nigrum. The shading will be somewhat
dark, but the picture cannot be drawn without it. Who does not
know that doctors, though clever and kind to most persons, are rep-
rehensibly less so towards each other than the members of any other
profession. How shall we solve the problem ? What is the cause
of this ? According to the present state of things, the physician
who rises in his profession, must, unfortunately, incur the penalties
of persecution, opposition and defamation, from his brethren. Emi¬
nence must be obtained and maintained in despite of professional op¬
position and detraction. If any one expects to avoid these, he must
stand still and give place to others. It may be said of the physician,
as is said of the christian, in principle at least, that if any man will
speak learnedly, practice skillfully and succeed eminently, he shall
suffer persecution.' I have something just in point here, fresh and
warm from the heart and pen of one who wrote lately from personal
experience. Hear him : " The practitioner of medicine has, how¬
ever, many trials and difficulties to encounter. If his calling be so
exalted, and his mission to suffering humanity so valuable, it will cost
him many sacrifices and be productive of cruel disappointments. If
he so frequently secures to himself the approbation and the love of
his patients, he must expect that many will criticise, revile and de¬
fame his character."
There are some, indeed, whose lips are so instinctively set to the
word " humbug," from a conscientious feeling of its applicability to
26
TRANSACTIONS OF THE TENNESSEE
their own selves, that they oppose all professional eminence and suc¬
cess with the cry of " humbug." It is their mode of persecution.
After all, I do not think that physicians are worse than other
men, or more invidious; these things spring not up so much from bad
hearts as from the very nature of our profession. Though physicians
may not be inclined to take advantage of each other, yet, when one
is dismissed, and another called in, some fortuitous turn in the case
may injure or almost ruin the first one in the estimation of the com¬
munity. Physicians are generally aware of this, and hence are jeal¬
ous of each other. The people are bad judges of the like, and the
aspiring doctor feels all the while determined to protect himself
against such things. The people are better judges of lawyers and
other public men, than of doctors. With the doctor it may be said,
sometimes, " A word of praise exalts, and a word of censure over¬
throws."- It is not so much feared by the doctor that his honorable
competitor will, in that way, get the advantage of him, as much as
fie fears that the personal and leading friends of his competitor may
do so. Hence a physician must gain a reputation which defies the
ordinary uncertainties of his profession ; it is then and only then that
he can feel secure amidst the opposition by which he is surrounded.
It is then and then only, that no advantage can be taken of him by
doctors or the people. A well earned and a well established reputa¬
tion will cover a multitude of professional uncertainties ! This sub¬
ject might be extended into an independent essay, and I almost wish
I had selected it for one on the present occasion.
How does Medicine differ in the nineteenth century from its state
among the Hebrews, Egyptians, Greeks, Arabians and Romans ; and
what are the differences of its relations to the world at this time?
A full answer to these questions would at once bring forth the
agreeable part of our picture in pleasant and prominent relief, out
of the shadings already cast.
Clinical Medicine is now placed upon a broad, appropriate and se¬
cure basis—its materia medica is full and well defined—its means of
diagnosis are multiplied and improved—its pathology is greatly eluci¬
dated and carefully studied, according to its signs, both in the living
and the dead. It has been greatly enriched by the discovery of aus¬
cultation and percussion, and other means of diagnosis, also by the
discovery of some new remedies and the improvement of old ones.
Surgery has also been greatly improved—it is now based upon
general, special and pathological anatomy—also upon highly impro¬
ved principles—and its former painful and bloody operations have, by
STATE MEDICAL SOCIETY.
the discovery of the ligature and chloroform, been converted into al¬
most painless and bloodless ones !
Midwifery has now, in the full sense of the term, become a scientific
branch of Medicine—its obstetric anatomy, its scientific principles, its
forceps, its ergot and chloroform, extend it even into a noble branch,
unlike any thing known by the ancients And the time would fail me
to tell of the improvements in chemistry, in materia medica, physi¬
ology and general pathology.
All the great branches of Medicine are in the hands of able medi¬
cal philosophers in Germany, France, the North of Europe, England
and America.
The lights of medical science are not now put under a bushel, as
formerly, but upon a candlestick, and they give light unto all the
world, through many great schools and many able journals ; and I
might mention many names just here, as burning and shining lights
of our own day, but it would be wrong to mention some without all;
besides, they are too well known to the profession to require a recital.
The last division of our subject must not be crowded out, hence, I
must desist here, and look prospectively into the future.
We have seen in our retrospective and perspective views of Medi¬
cine, that its state and progress were influenced greatly by the times,
in different ages ; and as they are now more favorable to the rapid
development of its collateral sciences, than at any other period of the
world, more may be expected from the present than any preceding
age.
They who have an eye to see it, must admit, that the present ten¬
dency in all things is to an equilibrium, and especially to the equali¬
zing of knowledge. The great fountains of accumulated knowledge
in Germany, in France, England and America, are now being gene¬
rally opened, and their radiating streams are being conveyed by
modern facilities to all parts of the earth. We shall not now have
the mere re-action of stagnant pools upon themselves, but their be¬
nign effects upon the world at large—from which will come a health¬
ful and profitable reaction. It may require a short time thus to
equalize knowledge, and some time may be spent in that way ; yet all
the while, many will be taking the lead in science, and while doing
so, will derive great advantage from an educated and scientific world.
Thus the chances of new and valuable discoveries in the different de¬
partments of Medicine are far, very far, greater than in former ages.
And though there are many things which will live and perish only
with the world, yet other important means will be discovered. The
28 TRANSACTIONS OF THE TENNESSEE
lancet, the leech, the cupping glass, calomel, quinine, tartar emetic
and the Spanish fly, cannot be superceded. Other medicines may
rise and fall, and be finally dispensed with, but these cannot.
What are our professional wants ? Surgery and midwifery have at¬
tained nearly their perfection : much more cannot be reasonably ex¬
pected from either of them ; but this is not the case with clinical medi¬
cine. We want a remedy for consumption, and cancer, and more relia¬
ble ones for many other diseases. The question arises, shall such ever
be discovered ? does the world contain them ? or are any artificial
combinations capable of producing them ? I think we shall soon be
able to give an answer to the foregoing questions ; for if the world
contains the means, or if a combination of different things be capa¬
ble of producing them, they may yet be discovered. By the discove¬
ry of a more effectual remedy for scrofula, we may-learn how to protect
persons against phthisis. But does the pathology of these diseases
admit of any relief. Can tubercles and cancerous degenerations, with
all of their structural derangements, be ever cured by clinical medi¬
cines ? Judging from the past and present, I fear not, indeed ; and
more attention will, in all probability, hereafter be given to the means
of preventing than of curing them. We shall learn to seize
upon their early indications by signs we know not now, and by
the use of proper measures, protect patients from further progress of
such maladies. Some modern Jenner may yet give the world an anti¬
dote against these diseases. It is highly probable that in a short
time we will have able scientific men engaged in the treatment of such
affections ; when we shall have a separate branch of medicine for
every organ—as separate and respectable as surgery and midwifery
are in our day. Hence we may soon look out beyond occulists, den¬
tists, lithotomists, for pneumatologists, gastrologists, hepatologists,
spermatologists, and in short, a name and a doctor for every part of
the system, whose, care and duty it shall be to treat the diseases of
one particular organ in an ojpen, scientijie way. The men who are
now engaged in a quackish practice of this kind will have to give
way to able scientific men, as did the barbers, and bath-men, and
slaves of old in surgery, and as did silly women and ignorant preten¬
ders in midwifery. The obstetrician and surgeon is not more distinct
now, than will be pneumatologists, gastrologists, &c., in a coming
day. And when great minds shall be engaged according to profes¬
sional interest, zeal and emulation, in such investigations, we may ex¬
pect all that can be achieved by man, aided as he will be by strong
collateral lights on every hand. Medicine does not now, as in former
state medical society.
29
times, pertain to one or two countries, but to the whole world. All
scientific knowledge is fast being equalized throughout the world.
The world will have no more dark ages. All will be ages of incon¬
ceivable light. We may say of the sun of science, in degree, as was
said of the Son of Righteousness, it will arise over the whole
earth with healing in its wings. Nation shall no longer learn the rudi¬
ments of science from nation, but all shall be taught, from the least
to the greatest, the things that promote man's good here. " The
farthest verge of the green earth," shall rejoice in the light of science,
and by it, " the most distant barbarous climes" shall be softened
down ; and all the nations of the earth shall become one in the great
light which is now pervading the whole face of the earth, and a
strong intellectual union be thereby established among all mankind.
REPORT ON THE ADULTERATION OF MEDICINES,
CHEMICALS, DRUGS, &c.
By Richard 0. Currey, M. D., Nashville, Tenn.
As Chairman of the Commit'tee appointed at your last annual ses¬
sion to report on the adulteration of drugs, medicines, chemicals,
<&c., I beg leave to present the following for your consideration. In
the prosecution of this duty, I had fondly hoped to have the assist¬
ance of others on the committee, but failing in this desire, I am under
the necessity of presenting an individual report:
The subject submitted for investigation is as important to the
healthful progress of your noble profession, as it is conducive to the
well-being of the family of man. The diseases incident to life are,
of themselves, sufficiently painful and obstinate, without requiring the
aid of adulterated and deteriorated medicine to aggravate them.
It is needless to enlarge upon the high mission of the profession of
medicine, to remind this learned association that, in all of the eras
that mark the progress of the human family, the physician and his
remedies have occupied a commanding and influential position.
Neither is it necessary to remind them of the sacred character
which their science possesses, from the designation which the Saviour
of mankind, in his mission of love, assumed as the Great Physician.
To imitate His piety, His disinterestedness, His benevolence, and His
readiness to aid the distressed and relieve the sick, should be the de¬
sire of all those who engage in the humbler avocation of administer¬
ing to the relief of the diseases that flesh is heir to. Regarded by
the light of this bright Exemplar, what are the results that flow from
the physician's mission ? Are they commensurate with the high esti¬
mate placed, by the common consent of all, upon his profession 1
Does he secure the end which it is designed to accomplish ? Has he
the talisman by which he can stay the ravages of disease, and send
joy and hope, with renewed life, coursing through the veins of the
desponding patient ? Does he avail himself of the right and proper
■means for restoring the health and preserving the lives of those who
confide in his skill ? If he be thus panoplied, success will attend him
in all his labors, and his very entrance into the chamber of sickness
will inspire hope and revive the desponding spirit.
STATE MEDICAL SOCIETY.
31
But why is it that the medical attendant is so often baffled in his
attempts to alleviate pain and cure disease ? Why is it that from
samples of the same medicine, prepared by two chemists, different
effects are produced ? With high hopes and ardent aspirations, the
young physician starts out on. his career, and fresh with the honors of
college upon him, fondly expects to meet and successfully contend
with disease on every occasion. Cases frequently occur which resist
his most reliable agents, and often he is reluctantly driven into feon-
sultations by anxious friends, with those whose qualifications, per¬
haps, are inferior to his own. And he has, perhaps, had the addi¬
tional mortification of seeing diseases yield to the treatment of the
consulting physician, when, it may be, no change had been made in
the remedial agent. Thus when a remedy fails, after repeated trials,
to produce the desired effect, it is useless for the physician, and dan¬
gerous for the patient to persist longer in its administration. A phy¬
sician, who regards his own repntation, as well as the life of his fel¬
low man, will not allow himself to be thus thwarted in his labors.
The use of impure medicines can never avail as a plea for the want
of success. It is not enough that the physician is accurate in the di¬
agnosis he forms of disease—he should know, and that without the
least shadow of a doubt, that the remedy he employs is pure and gen¬
uine. That adulterations do exist, the experience of the medical
profession has sadly felt. Sometimes the fact is plainly established
in the inertness of the remedial agent, at others in the aggravated
effects resulting therefrom : and then chemical analysis, the revealer
of dark deeds and hidden secrets, brings up to the light of day the
baseness of sueh frauds. Standing by the bedside of the dying
friend, we may have been the saddened spectator of the unyielding
nature, as we supposed, of the disease ; but the analyst reveals to our
astonished gaze the medley of impurities which we had been pre¬
scribing for its cure—proving to us that our labor has been in vain,
and worse than in vain. Two witnesses, therefore, experience and
analysis—the sick couch and the laboratory—testify to the base char¬
acter of many of our medicinal agents. That this expression is not ex¬
aggerated, allow us to pass in review our most familiar and most use¬
ful medicines. And that this sketch may be useful, we accompany
the description of each medicine with an account of the agents with
which it is most generally adulterated, as well as the tests for their
detection :
Aloes.—Of the six varieties of this resinous extract, only three are
of sufficient importance to merit notice, the cape, hepatic and socotrine,
32
TRANSACTIONS OP THE TENNESSEE
and of these the last is the most valuable. The usual adulterations
are sand, earth, &c. ; but more frequently fraud is practiced in palm¬
ing off the two inferior for the more valuable socotrine. There are
characteristic properties belonging to both, however, which will guard
the purchaser, in some degree against imposition.
Cape aloes possesses a shining, resinous appearance, a deep brown
color, and a glossy resinous fracture. Its powder is greenish yellow,
and produces a paler colored decoction than the other kinds. Its
odor is strong. Thin laminae present a yellowish, red color, when
held up to the light.
Hepatic aloes is opaque—of a liver color, whence its name—of a
moderate degree of fragrance, it might be called unpleasant. Frac¬
ture rough and semi-transparent on edges. Powder dull olive yel¬
low. When held in the hand it softens and adheres.
Socotrine aloes gives a glossy, smooth and conchoidal fracture—is of
a garnet red color, and yields a golden yellow powder. Thin laminae
are translucent, or nearly transparent on the edges. Its odor is
highly fragrant, which is, to a great degree, given off, when a por¬
tion is heated.
Alum, which is the sulphate of alumina and potassa, chrystalizes
in regular octohedrons, but is, in the commercial article, without reg¬
ular form. It is adulterated with iron, thus rendering it unfit for
the dyer. It should give a colorless solution. Tincture of nutgalls,
or prussiate of potash, will detect, in such solution, the presence of
iron. TJnslacked lime, added to the dry powder, will give off the
odor of ammonia, if that alkali be present, and nitrate of silver will
detect the existence of chloride of sodium, or common salt.
Ammonia aqua.—We have in commerce, five strengths of this al¬
kali, designated as F., FF., FFF., FFFF., and blistering ammonia*
When adulterated with organic matter, a carbonaceous substance will
be left after evaporation by heat. The addition of muriatic acid
forms sal ammoniac, which, if resinous matter be present, will not be
pure white or clear, when evaporated. Lime water will detect the
presense of carbonate of ammonia, by forming an insoluble carb.
lime. Nitrate of silver will detect the presence of mnriate of ammo¬
nia by forming the white chloride of silver, usually termed horn-
silver, and chloride of barium will throw down an insoluble sulphate,
if sulphate of ammonia be present.
Carbonate of ammonia volatilizes entirely by the application of heat,
and effervesces on the addition of an acid.
STATE MEDICAL SOCIETY.
33
Tartrate of ammonia and potassa, when in the ehrystaline form, is
readily recognized, being in white, transparent, rhombic, octahedrons,
whose lateral planes present a striated appearance. When powdered,
it readily admits of foreign admixture, the most usual of which is the
bitartrate of potash. If the powder has a yellowish tinge, the pres-
enbe of iron may be suspected, which may be detected by adding to
its solution a few drops of sulphuric acid, and subsequently the prussi-
ate of potash. If then the characteristic blue prussiate results, iron
is present. If the bitartrate o-f potash be present, its solution in 40
parts of water will be effected by its own volume of 8 parts acetate
of lead in 32 parts water and 15 parts acetic acid.
Arrow root, from the Bast Indies, does not crepitate between the
fingers, like that from Bermuda or the West Indies. When pure,
full 15 minutes are required for it to gelatinize and become adhesive,
whereas potato starch; with which it is adulterated, rapidly stiffens
and becomes tenacious. The microscope will detect the different va¬
rieties of starch granules that may exist in the arrow root.
Arsenic, being very volatile, a residue will be left, if white sand,
chalk, bone dust, or heavy spar, its usual adulterations, be present.
Sub-nitrate of bismuth effervesces, if chalk or carbonate of lead be
present, on the addition of nitric acid. Diluted sulphuric acid will
throw down from this nitric acid solution a white precipitate, if lead
be present.
Cantharides deteriorate by age and by exposure to damp air, and
are also subject to be attacked by mites. In the powder or plaster
they are adulterated with euphorbium,' which also possesses irritating
and vesicating properties. The presence Of this adulteration may be
ascertained by heating the substance, when, if a benzoic acid vapor
be given off, its presence is established. The microscope may also
detect its presence; To this may be attributed the frequent inertness
of the cantharides plaster of the shops, as well as to an insufficient
quantity of the Spanish fly.
Castor oil is the only one of the fixed oils soluble in alcohol—hence
this affords a test for lard oil or any other cheaper admixture. Cas¬
tor oil capsules, containing but a very small portion in each sac, would
be insufficient to produce a purgative effect, were not this compensated
by the addition of a minute portion of croton oil. Instances have
occurred of painful and even fatal gastritis, resulting from the admin¬
istration of these capsules.
Chloroform, when pure is perfectly transparent, sp. gr. 1, 5. It
possesses an extensive solvent power, thus rendering it valuable as an
2
34
TRANSACTIONS OF THE TENNESSEE
analytical agent in separating substances from their foreign admix¬
tures, as resin of guaiac from resin of jalap—cinchonia from quinia,
and narcotina from morphia. Pure chloroform, when allowed to
evaporate on the hand, leaves no smell. If an unpleasant odor re¬
mains, it is evidence of the presence of some peculiar oil, which is
not volatile, and which has been generated during the manufacturing
process. It is also supposed that the presence of these oils may be
tested by the discoloration of pure sulphuric acid, though the experi¬
ments of others have not confirmed the supposition. Instances have
frequently occurred of death resulting from the use of chloroform.
This is doubtless owing to the impurity of the article, not because it
is of itself thus fatal. Perfectly pure chloroform has never poduced
such results. Can it be otherwise when we find it varying in strength
from one twentieth to three-fourths of what it should be. Free chlo¬
rine and hydro-chloric acid have been detected in it by the litmus pa¬
per. If alcohol be present as a diluent, the bichromate of potash,
with a few drops of sulphuric acid, will cause the production of the
green oxide of chromium, floating on the surface. There has also
been noticed the formation of minute chrystals, of a pink color, on
the sides of the bottle on the upper surface of the fluid, an impurity
resulting from the oxide of manganese, used in its purification. To
be a safe remedy, its sp. gr. should not be less than that indicated,
1, 5 ; while it should be fragrant and clear—no unpleasant odor on
evaporation—should not redden or bleach litmus paper, nor give a
greenish tinge when agitated with sulphuric acid.
Cinchona is estimated by its external as well as chemical charac¬
ters. So many different varieties of this truly valuable bark have
been found, that the strictest vigilance is necessary to prevent fraud
in its importation into our ports. Its value is determined according
to the quantity of quinia it yields. Recently a new principle has been
discovered in some barks brought from Carthagena and Maracaibo,
called quinidine, from its great resemblance, in all its characters, to
quinine, though as an anti-periodic it is valueless. M. Guibourt reck¬
ons the value of the different cinchonas thus :
1. Calisaya cinchona, royal yellow.
2. Cin. micrantha, orange yellow.
3. " Pitaya, " "
4. Verrucous true, red.
5. Non-verrucous true, red.
6. Red Lima.
V. Grey Lima.
STATS MEDICAL SOCIETY.
85
The calisaya bark is distinguished from all others which are fraud¬
ulently mixed with it, by "the shortness of the fibres of the entire
transverse fracture, and the ease with which they are broken, instead
of bending and remaining adherent."—(Prof. Carson, in Am. Jour.
Pharm. April, 1850.) Its color is uniformly yellow, and possesses
no white marbling in its thickness. The nail, when drawn over its
internal surface, leaves a shining mark, and its outer surface is con-
choidal. Calisaya has, also, a more intensely aromatic, bitter taste
than the other barks, this characteristic varying even in its different
varieties. At the recent National Pharmaceutical Association, Dr.
Bailey reported that he had rejected at the port of New York,
800,000 lbs. of spurious bark, especially of that variety that contain¬
ed exclusively the newly discovered principle, quinidine. He was led
to reject them from the conviction that they were to be employed in
the adulteration of powdered calisaya, as well as of quinine. The os¬
tensible object for which they were imported was the manufacture of
tooth powders. The price of barks in good condition and of good
quality, at the place of collection, is said to be not less than from 60
cts. to $1,00 per lb., for those yielding quinine—on the contrary, it is
frequently invoiced to this country at 10 cts. per lb. As it takes 2 oz.
to make one ounce of quinine, it may be readily conjectured why it is
that quinine can be sold sometimes as low as $2,00 per oz., and the
powdered bark as low as fifty cts. and $1,00 per lb.
Citric add belongs exclusively to the vegetable kingdom, being
found in lemons, limes, sour oranges, tamarinds and tomatoes. The
juice obtained by expression is readily chrystalized in white, inodo¬
rous, rhomboidal prisms. They possess a sharp, sour taste, are solu¬
ble partially in water, and insoluble in alcohol. Its value subjects it
to sundry adulterations, as lime, tartaric acid and sulphuric acid.
With chloride of barium, sulphuric acid, if present, is precipitated as
an insoluble sulphate of baryta. Muriate of potash detects the tar¬
taric acid by the formation of a tartrate of potash, and lime will be
left after incineration. The lemon syrup of commerce, is more fre¬
quently made of tartaric acid than of either citric acid, or of the
pure juice of lemons. According to Soubeiran, citric acid precipi¬
tates baryta, and not lime, from their solutions, whereas tartaric acid
exerts the contrary effect. Moreover, citric acid is deliquescent,
while tartaric acid is not.
Cod liver oil has become so popular in the treatment of diseases of
the chest, similating phthisis, that it is subject to various adultera¬
tions, the most common of which is sperm oil. Pure od ^ w
36
TRANSACTIONS OF THE TENNESSEE
odor of sardines, and is free from the lamp oil odor—sp. gr. 9, 1.
With nitric acid of sp. gr. 1, 215, a dull green hue is generally as¬
sumed, which, after several days, changes to brown, whereas sperm
oil, with an acid of same sp. gr., produces a pale brown without a
shade of green. Besides this impurity, which is intentionally mixed
with it, others are attributable to want of care in assorting the cod
from the haddock, the hake and the pollock, certain species of the finny
tribe which accompany the cod in their haunts, and which are conse¬
quently caught at the same time.
Balsam Copawa.—M. Guibourt, acting under the authority of a
commission from " Ecole de Pharmacie de Paris," after examining a
variety of samples of this oleo-resinous balsam, asserts that the four
following properties indicate a balsam that is certainly pure : 1. En¬
tirely, soluble in 2 parts of absolute alcohol. 2. Forming at 60 F.
a transparent mixture with two-fifths of its weight of a strong solu¬
tion of ammonia. 3. Solidifying with one-sixteenth of its weight of
calcined magnesia. 4. Producing a dry and brittle resin after pro¬
longed ebullition, with water.
Its usual impurities are castor oil and turpentine. The presence of
this fixed oil will prevent its solubility, according to the first proper¬
ty ; neither will the resin left after ebullition harden, but will remain
soft. A drop on paper, volatilized by heat, leaves a translucent spot,
if pure, but if impure, this spot will be surrounded by a fatty areola.
Castor oil will also prevent the transparency of the mixture with the
solution o,f ammonia. The turpentine is detected by its .odor.
Creosote.—The physician often meets with two varieties of creo¬
sote—the one pure and colorless, the other impure and reddish, with
an empyreumatic odor. The adulteration in the impure is owing either
to rectified oil of tar, or a peculiar article called capnomer, which, in
many of its physical and chemical properties, is similar to creosote.
The presence of these impurities may be detected by acetic acid and
caustic potash, which completely dissolve the creosote, if pure, but if
adulterated, will not.
Cubebs, in the powder, is adulterated with ground allspice, by
which the taste will be so altered as to lead to their detection.
Ergot, in the powder, is rendered inert by the admixture with plas¬
ter and paste.
Ether, sulphuric, has a permanent boiling- point at 98 F. The ad¬
dition of impurities will have the effect to raise it to a higher y>oint,
Turpentine will also cause a nauseous odor to remain after moisten¬
ing a handkerchief with it.
STATE MEDICAL SOCIETY.
87
Gum Arabic, when pure, is in round, white lumps, or in masses pre¬
senting a brittle and crackly appearance. Its pure appearance dis¬
tinguishes it from the inferior sorts, with which it is sometimes mix¬
ed. Gum Senegal is, however, bleached for this express purpose.
The pure gum, is perfectly soluble in water without swelling, from
which solution it is precipitated by alcohol. The salts of the per¬
oxide of iron yield an ochre precipitate with gum Senegal, while a red
coloration will be afforded with the true gum Arabic. It is in the pow¬
dered state that these tests are of the most value, when it is impossi¬
ble to detect by the eye, as can be done in the solid state. If starch
is with the powder, it may be tested by iodine—the characteristic
blue being produced.
Iodine, that has not been resublimed, is always more or less impure,
hence we 'have a commercial and a resublimed article. It has been a
mooted question whether the operation of the law is adverse to the
admission of the commercial iodine, on account of its impurities, into
our ports, and so far the action of our inspectors, as well as instruc¬
tions from the Secretary of the Treasury, have been against its ad¬
mission. The most common Impurity with which the commercial is so¬
phisticated is the large proportion of water. The standard of purity
adopted by the inspectors, will not allow of more than 2 per cent,
of water, yet it is found of all grades, varing from 2 to 20 per cent.
An argument offered for the adihission of such is drawn from its em¬
ployment in the manufacture of the iodides, and for daguerrean pur¬
poses, for which it is said to answer as well as the resublimed. The
law, however, is express on this subject, forbidding the importation
of any medicine or chemical that is not pure enough far medicinal
purposes, and, as it is conceded by both parties, that the commercial
is not of that purity, it is very properly excluded. 1 At the recent
National Pharmaceutical Association, Dr. Stewart, to get at the
sense of the members on this subject, introduced a resolution to the
effect, that all, articles, good of their kind, should be passed at our
ports. As the importers of this commercial article acknowledge their
design to be for manufacturing purposes, it was urged that it should
be admitted. The whole subject was discussed—Prof. Carson of the
University of Pennsylvania, among others, taking a part in it, yet
the resolution was rejected.
Other impurities found in this chemical are black lead, charcoal, black
oxide of manganese, galena, sand,. clay, and chlorides of magnesium and
of calcium, and free chlorine. Pure resublimed iodine is in dry, chrys-
taline scales. If they adhere to the sides of the vial, it is an evidence
38
TRANSACTIONS OF THE TENNESSEE
of the presence of water. If entirely vaporizable on application of
heat, it is an evidence of the absence of inorganic impurities. The
magnet will separate the black lead, which is truly a carburet of iron,
from the mass, if present ; it is also insoluble in alcohol. Muriatic
acid, mixed with it, will evolve chlorine, affording evidence of the
presence of oxide of manganese.
Ipecacuanha, root is composed of two parts, the cortex and woody
fibre in the proportion of 4 to 1. The virtues of the root reside ex¬
clusively in the bark, the woody fibre being inert. Hence it may be
seen that when the root is ground up, regardless of these distinctions,
one-fifth of its active properties is destroyed, consequently the choicest
powdered ipecac is labelled cortex sine ligno. The root is annulated,
rendering its recognition easy. Hence it is in its preparations and
powder that it admits of adulteration. Liquorice root is frequently
ground up to a large extent with it, and again, the peculiar powder
called "powder of post," is also added to it. This of course would
weaken its emetic properties, to restore which, its adulterators resort
to a certain proportion of tartar emetic. With the microscope we can
detect the different starch granules of these several powders—while
sulphuretted hydrogen will produce an orange precipitate, the golden
sulphuret off antimony, if tartar emetic be present. The presence of
foreign substances will also affect its action with certain chemical
agents.
Magnesia calcined.—This substance admits of such ready adultera¬
tion, that-it is rarely found absolutely pure. It is known to contain
carb. lime, carb. magnesia, alumina and silica. With the carbonates,
an effervescence will take place on the addition of an acid. A com¬
plete solution cannot be effected if silica be present, and the alumina
will afford a white precipitate with ammonia, if present in the muri¬
atic acid solution. If lime be present, oxalate of ammonia produces
a precipitate from the same acid solution. Carbonate of Magnesia is
also adulterated with the Same substances, and may be detected by
the same tests.
Blue mass—pilular hydrargyria if of the officinal strength, should
contain one-third mercury. While, therefore, it frequently falls far
short of this standard, it is also found to contain a strange medley
of impurities, as compensating agents. The following analysis, made
by Prof. Keid, of New York, upon a sample of imported blue mass,
presents these filthy substitutions in a , striking manner. In one hun¬
dred grains, there were of
STATE MEDICAL SOCIETY.
39
Mercury, 7|
Earthy Clay, 27
Prussian Blue, 1£
Lard, 2
Soluble saccharine matter, 34
Insoluble organic, " 12
Water, 16
Pure blue mass should contain 33£ grains mercury in 100. Here
we have only 7|—nearly four-fifths less than there should be. Sul¬
phate of mercury is also found in it, and when so, it renders the mass
highly injurious. This impurity arises from the gross error of endeav¬
oring to heighten the color of the conserve of roses by means of sul¬
phuric acid. Consequently, on mixing the ingredients into a mass, a
chemical action takes place—the deep blue color of the mass partakes
of a golden tinge, from the formation of the sulphate of mercury.
Its presence may be suspected when this particular tinge is found,
but readily ascertained after washing, by means of the baryta test.
The inorganic earths will be left after incineration of the mass, and
Prussian blue by striking an ink with sulphate of iron.
Mercury ammoniatcd, white precipitate, so closely resembles dry
white lead, calomel, chalk and gypsum, in several of its physical
properties, that it readily admits of adulteration. Pure white pre¬
cipitate may be entirely sublimed on the application of heat, being
resolved into mercury, nitrogen and hydrogen., If, therefore, any
adulterations exist, there will be a residue left.
Peroxide of mercury, red precipitate, is also readily susceptible of
adulteration with red lead, brick dust, Armenian bole, nitric acid,
and red oxide of iron. A strong heat will also readily vaporize this
substance, if pure ; if impure, a residue will be left. It is also en¬
tirely soluble in muriatic acid, and hence its impurities, if any, will
subside.
Protochloride of mercury, pure calomel, acted upon with a solution
of iodide of potassium, changes to a greenish yellow, and with lime
water or the caustic alkalies, it blackens. Treated with nitric acid,
it affords a white precipitate with nitrate of silver, soluble in an ex¬
cess of ammonia. The physical properties of calomel are well known,
being insoluble in water, alcohol, ether, muriatic or acetic acids, ino¬
dorous and tasteless. Its usual adulterations are chalk, gypsum,
phosphate of lime, carb. lead, sulphate of baryta, sal ammoniac, &c.,
and corrosive sublimate, through faulty preparation. The test of its
adulterations is easy, for it is entirely vaporizable by heat, if pure.
TRANSACTIONS OF THE TENNESSEE
The presence of corrosive sublimate is manifested by the yellow, not
black color, afforded by lime water, and a scarlet color with iodide of
potassium. Again, corrosive sublimate is soluble in ether and calomel
not. It may thus be separated, if present, and then, by the evapo¬
ration of the ether, the corrosive sublimate will assume a chrystalline
character. Three samples of calomel thus treated, gave, with the
delicate tests of ammonia and hydro-sulphuret of ammonia, indica¬
tions of the presence of the bi-chloride. Other portions of the same
were digested in water, over a water bath, kept at a temperature of
90 degrees, and the clear supernatant fluid being decanted and fil¬
tered, was tested and the same indications were afforded by ammo¬
nia and its hydro-sulphuret.
After the application of a strong heat, if a residue is left, its char¬
acter may be ascertained ; for if a carbonate of lime or lead, it is so¬
luble, with efferveseence, in dilute muriatic acid—if an oxide of
lead, hydro-sulphuret of ammonia will change it black, and yellow by
iodide of potassium—and if a white precipitate is afforded with oxal¬
ic acid and oxalate of ammonia, the residue is lime.
Bichloride of mercury.—Corrosive sublimate forms a yellow wash,
with lime water or caustic alkalies, thus distinguished from the black
wash of calomel. It is also soluble in ether, and less so in alcohol
and water. With iodide of potassium a scarlet precipitate is pro¬
duced.
Mercury, red sulphuret.—Vermillion is a paint, but the following
analysis shows its great impurity. Out of ten samples,
3 of the Trieste Vermillion were pure.
1 " " contained 15 per ct. carb. magnesia.
1 " " contained 26£ " " "
1 .French, " contained 35 per ct. sulphate of lime.
1 " " pure.
2 Chinese, " contained 48 and 62 per ct. chrom. lead.
1 American, " was entirely red lead.
Morphia and its salts are soluble in water and alcohol, and insolu¬
ble in ether. Of the three salts, the sulphate is determined by the ba¬
ryta test, the muriate by the silver test, and the acetate by the odor
of vinegar. Their impurities are sugar, narcotine, and perhaps starch.
Narcotine is insoluble in water, chloroform and solution of potash—
and soluble in ether, the action of solvents differing, in a remarkable
manner, with the two substances. The crystalline character affords
a good test, pure sulphate of morphia being in small filiform crystals.
The impurities present no such regularity. If pure, nitric acid gives
STATE MEDICAL SOCIETY.
41
to the salts of morphia a blood red color, changing to yellow—per-
chloride of gold affords a yellow, and the salts of peroxide of iron a
blue precipitate.
Essential and fixed oils are also contra-distinguished as volatile and
fat oils. The former being the more valuable, are adulterated with
the latter. The detection of such adulteration is, however,1 easily
made, for if a transparent, greasy stain is left, after the application
of heat to a drop on paper, it affords evidence of the presence of such
adulteration. All of the fixed oils, except the single instance of cas¬
tor oil, are insoluble in alcohol, while the essential oils are entirely so.
Chloroform is also a solvent for the essential and not for the fixed
oils. The fixed oils afford a saponaceous compound with alkalies—
the essential oils do not.
Opium is estimated according to the amount of morphia it con¬
tains. While, therefore, its adulterations may consist of sand, earths,
leaves, vegetable extracts, &c., these are nothing compared with the
fraud sometimes practiced of reducing the per centage of morphia
contained in the mass, by extracting it, to a certain extent, and then
remoulding the cakes and passing them into the current of trade.
Opium has been presented for admission into our ports that was so
impure, as to be actually alive with worms. This statement is made
by one of the examiners.
Pure Smyrna opium is in irregular, roundish masses, of a highly
bitter, nauseous taste, and brownish, red color, and more or less soft,
according as it is fresh or old. In Mohr's Treatise, a method is giv¬
en for ascertaining the proportion of morphia, and I beg leave to in¬
corporate a succinct account of it in this report: Half an ounce of
opium is to be macerated in an ounce and a half of cold water, for
twenty-four hours, then strain and strongly express. Repeat the
maceration for six, and then again for three hours. Prepare a thick
milk of lime with one drachm of quick lime, to which add the infu¬
sion when boiling hot. Boil for five minutes, then strain through
cotton cloth, wash the residue with boiling water, and express.
Evaporate the liquor thus obtained to one ounce, filter through paper,
and heat to boiling. Then, by the addition of one scruple of muriate
of ammonia, the impure morphia will be precipitated. Allowing from
six to twelve hours for the precipitate to collect, it is then to be dried
and weighed. This will afford the morphia exclusive of narcotine.
Bicarbonate of potassa crystallizes in oblique prisms, thus distin¬
guished from the carbonate, which exists in a granular form. It may
be remarked here that the crystalline form of the various chemical
42
TRANSACTIONS OF TflE TENNESSEE
compounds affords ready means for ascertaining their character. Ev¬
ery inorganic mineral, whether compounded in the laboratory of na¬
ture or of the chemist, possesses a certain definite crystalline form,
which it will assume at all times, unless the presence of a foreign sub¬
stance gives to the crystal-making particles different axes, and there¬
by creates a new and different form ; and such will be the result.
Crystallography, therefore, furnishes invaluable aid in chemical analy¬
sis. This salt of potash is adulterated with the sulphate, muriate and
carbonate. The sulphate is detected by nitrate of baryta, the muri¬
ate by the silver test, and carbonate of potash by the action of corro¬
sive sublimate—if even a trace is present, a brick red precipitate be¬
ing produced.
Bitartrate of potash is known in commerce only in the powdered
form, and is, therefore, frequently adulterated. Marble, alum, gyp¬
sum, bisulphate of potassa, flour, rice and starch, are used for this
purpose. C. V. Hagner, in the American Journal of Pharmacy, gives
his experience in drug grinding. It was with this article that he
commenced this business. For many years he had the entire control
of such work, until his process became known, and rival establish¬
ments sprang into existence. One of these establishments failed, and
one of the hands sought employment with him. He could do every
thing—" powder this, powder that, and grind 'tother—never had any
difficulty except in grinding cream tartar." I expressed, says Mr.
Hagner, my astonishment, knowing it to be the easiest thing in the
whole catalogue of drugs to powder, and on asking him what the
difficulty was, he replied, quite innocently, " the alum always sticks the
stones fast J
In testing it for its impurities, marble and gypsum will remain un¬
dissolved in any amount of water—alum will be preciptated in a ge¬
latinous form, by heating the solution to the boiling point, and then
adding ammonia until the liquid acquires an alkaline character.
Iodide of potassium.—The principal adulterations of this valuable
medicine are carbonate of potassa and chloride of sodium. Iodide
of potassium is very soluble in water, and in five times its weight of
alcohol—is slightly deliquescent and of a pungent taste. Carbonate
of potassa is insoluble in alcohol—is very deliquescent, and conse¬
quently its presence will cause the iodide to assume a pasty, semi¬
fluid condition. It will also effervesce with acids, and redden tumeric
paper. Either of the chlorides may be detected by the silver test.
The quantity of iodine present may be ascertained by separating it
from the potassium by heat, condensing the scales and weighing either
STATE MEDICAL SOCIETY.
43
of the ingredients separately. In a sample analyzed by Dr. Christi-
son, he found 14 parts of carbonate of potassa, 16 of water, and
only 9 of the iodine.
Sulphate, of Quinine.—The ingenuity of man has been at work to
discover substances with which to adulterate this valuable medicine.
Whatever would the more closely resemble it in its physical proper¬
ties, seems to have been sought out with avidity for this base pur¬
pose. At one time cinchonine was made to retain its place with the
chemical—then salacine was ascertained to possess somewhat similar
properties, and was mixed with it in large quantities—and then
again mannite, and stearine, and starch, were severally used for the
purpose. But a new principle has been recently discovered in a spe¬
cies of Peruvian bark, found in Maracaibo and Carthagena, which,
from its great resemblance to quinine, has been called quinidine.
There is not the least doubt that our valuable sulphate is largely
adulterated with this inert substance. So fully impressed have our
examiners been with this belief, that they have rejected large quanti¬
ties of these false barks. Zimmer has published a sure test for this
new principle, which is as follows : To ten grains of the salt add ten
drops of diluted sulphuric acid and fifteen drops of pure water, in a
strong test tube fitted tightly with a cork, and apply a gentle heat to
accelerate the solution. When cooled, add to the solution fifty drops
of officinal sulphuric ether, with twenty drops of spirits of ammonia,
and shake the mixture while the top is closed by the thumb. The
tube is to be then closely stopped and shaken gently from time to
time, so that the bubbles of air may more readily enter the layer of
ether. " If the salt examined be free from cinchonine and quinidine,
or contain the latter in no greater proportion than ten per cent., it
will be completely dissolved ; while, on the surface, where contact of
the two layers of clear liquid takes place, the mechanical impurities
only will be separated. If more than a tenth of cinchonine or quini¬
dine be present, an insoluble precipitate will be found interposed be¬
tween the two fluids. If it be quinidine, it will be dissolved on the
addition of ether, while cinchonine will remain unaffected." Two sam¬
ples of quinine, tested according to this method, produced very differ¬
ent results ; while one was quite pure, the other was just the reverse.
( A sample of quinine, of the same brand as the last mentioned in the
text, but from another lot, has recently been examined by me and
found pure. Also another sample taken from a jar of an English
manufacturer was found pure. It is due from me to state, that the
two samples mentioned in the text, were neither of them obtained from
44
TRANSACTIONS OF THE TENNESSEE
the manufacturers.^ Other impurities maybe detected as follows :
Gypsum, chalk and magnesia are left undissolved—boracic acid is so¬
luble in alcohol, and tinges the flame green, if ignited. Cold sulphu¬
ric acid, C. P., will not form a colorless solution if stearine, mannite
or salacine be present.
JRkuharl may be obtained of two varieties, the Chinese or India,
and Russian or Turkey. The English, though sometimes substituted
for the other sorts, is very inferior, and not at all reliable. This, and
also the India, are assorted, and the better "specimens disfigured to
resemble the Turkey, as much as the fifth of a cargo being found
to be these inferior sorts. To lighten the color, tumeric is rubbed
over the root, or mixed with the powder, to which there is also ad¬
ded a proportional quantity of gamboge to increase its cathartic ef¬
fect, This may be detected by digesting in ether, and pouring a few
drops of the solution on water ; "if gamboge be present, a film of
opaque yellow color will be found floating on the surface, which is
dissolved by potash, and is changed to an intense red color." It is
stated that within 80 days previous to the passage of the Drug Law,
by Congress, 7,000 pounds had been passed through the Custom
House of New York, not one pound of which was fit for use. Some
were worm-eaten, others deteriorated by age, and the remainder had
evidently undergone maceration to extract the active properties for
the preparation of extract of Rhubarb. And doubtless all of this
was subsequently powdered, and so fixed up as to sell for a high price
as true Turkey rhubarb.
Scamyiony.—One of the rarest medicines to be found is Pure, or
Virgin Scammony. It bears a high price, and both physicians and
apothecaries seem more content with the cheaper adulterated article,
than to risk the sale, or incur the expense of the genuine. Of the
three varieties, the Smyrna is good for nothing, the Aleppo contains
about 30 per cent, and the Virgin Scammony 78 per cent. The Lan¬
cet for February, gives an account of the examination of thirty sam¬
ples procured in London. Out of thirteen samples of Scammony in
cake, one only was genuine ; the other.s being adulterated from 8 to
75 per cent. One sample was entirely fictitious, being composed of
the resins of guaicum and jalap, with woody fibre, cellular tissues, &c.
Out of seventeen samples of powdered Scammony, only one was
genuine, the others varying in adulteration from 18 to 65 per cent.
The adulterating substances consisted of chalk, wheat flour, sand and
earthy substances, gum, woody fibre and cellular tissue. Pure Vir¬
gin Scammony should contain 78 per cent of resin. Chalk will be
STATE MEDICAL SOCIETY.
45
detected by effervescence with acids, and flour or starch, by the
Iodine test, and by the microscope.
. Nitrate of Silver is offered forj sale in the form of pure crystals, or
in rolls or sticks, designated as No. 1 and No. 2. The three vary¬
ing in purity from the pure to 60 per cent, and 30 per cent. The
adulterations of this last are so abundant as to render it unsafe for
administration. For internal use none but the pure should be
used. The usual adulterations are nitre, lead, zinc and copper. Hy-
drocloric acid will detect nitre, by separating the silver as an insolu¬
ble chloride, and then testing for the nitre in the solution. Copper
will afford a blue color, with caustic ammonia, and lead will be black¬
ened by sulphuretted hydrogen.
Spirit of Nitric Ether.—Nothing is more common than to dilute
this valuable diaphoretic with variable proportions of water and
alcohol. Hence the physician is often disappointed in the result deri¬
ved from its employment. Water having the effect to render it heav¬
ier, will raise its specific gravity, and alcohol will change its odor.
The commercial article generally contains 33 per cent of water.
Thus much for the analytical view of our subject. There is another
means within our power for exposing these base frauds. The eye,
aided by the microscope, can be familiarized with the appearance of
pure and genuine substances, and fails not to detect the mixture of
one with the other. The forms of crystals readily reveal to us their
chemical character, according to that law of the crystalline forces,
that a substance will assume the same crystalline form, if left alone or
unmixed, wherever made ; but it was not until recently ascertained
that the microscope would subserve such an important purpose in the
examination of powders and other medicines. Organic products
• have been found to possess as great a diversity in crystalline form
as inorganic, and consequently, according to Dr. Pereira and Mr.
Queckett, may be used as a criterion of their purity. They may thus
be referred to their respective origins. These indications are offered,
it matters not how minute they may be, in the form of the cells, the
shape of the starch granules, and the condition of the spiral vessels
of the organic product. Of course, the examiner should be acquain¬
ted with the appearance of undoubtedly pure substances, so as to
insure correctness in his conclusions.
These are the means'within our reach for the detection of adulte¬
rated medicines. Not one, but every important remedial agent, has
been subjected to adulteration. It were well if the substances em¬
ployed for this purpose were inert or innocent, and thereby produc-
46
transactions of the tennessee
tive only of delay ; but frequently they are of such character as to
render them highly injurious, aggravating the disease, if not placing
the patient's life in jeopardy. Much of the inefficiency of medical
practitioners may be attributed to these causes. Here, too, is af¬
forded an apology for the apparently bold practice of many of our
medical men. Small portions of quinine failed in their effects, and
the remedy was pushed to Herculean doses, and still no quininism re¬
sulted. Teaspoonfuls of calomel have found their way, in single
doses, through the system of the sinking patient, and yet it failed in
its effect, and emesis has not followed ; nor even nausea, from the ad¬
ministration of dessert spoonfuls of ipecac. Where such things hap¬
pen, the physician is not the sole loser. Mortification and chagrin
at such repeated failures, it is true, have dampened his ardor for his
favorite science, and it may be, he is ready to join in the taunt and
cry out, "Throw physic to the dogs;" but the suffering patient,
either in his prolonged pain, or its aggravation, feels more keenly the
fraud practiced at his expense.
The Sources of Adulterated Medicines.—We are led to inquire
into the sources of these frauds. They are two fold—-foreign impor¬
tations and home manufacture. We are dependent upon other coun¬
tries for the most valuable of our medicines. Many are imported di¬
rect from the countries that produce them, others come to us after
they have found their way into some European laboratory or drug
house. We import, therefore, extracts and chemical preparations, as
well as the original roots, leaves, barks and flowers. It is not strange,
therefore, that attempts should be made, and with success, to intro¬
duce spurious and adulterated articles into our country. So exten¬
sive had this nefarious practice become, previous to 1848, that every
ship that was borne on the wings of the wind across the ocean, was
freighted with these missiles of death. Stringent laws prevent the
sale of deteriorated and adulterated medicines in all European coun¬
tries ; consequently, when such were found to be accumulating, they
were overhauled, their form changed to a powder or extract, and a
cargo put afloat for the American market. No laws existing here
to prevent their admission, provided they were invoiced by their
proper name, with correct weights, they were passed, and eagerly
bought up at reduced prices, for the western trade. Into this valley,
so recently a wild forest, where the " medicine man" of the Indian
held his sway, and sought his remedies from her productive bosom,
the adulterated and deteriorated drugs of other countries poured like
an avalanche from the mountains upon us, to poison and kill the life-
state medical society.
47
blood of the sons and daughters of our people. Too much praise,
therefore, cannot be meted out to those who, in 1848, resolved upon
checking this baneful tide that rolled upon our shores. Fortunately
for suffering humanity, there was one in our Congress, Dr. Edwards,
a member from Ohio, who felt the importance of this subject. The
petitions that went simultaneously from the colleges of pharmacy and
medical associations, were referred to a committee, of which he was
chairman, and his report presented such startling disclosures to the
consideration of the House, that a law was proposed as a remedy for
the evil. To the praise of the College of Pharmacy of New York,
be it recorded, that they were the first to move in this measure, by
the publication of a series of appeals to the proper authorities. The
Philadelphia College of Pharmacy added the strength of its testimo¬
ny, and in May, 1848, the American Medical Association, while con¬
vened at Baltimore, planned a memorial to Congress. Their appeals
were heard and appreciated. It was expected that active measures
would be resorted to to impede the progress of such a law before
Congress, and that, if adopted, obstacles would be thrown in the way
of its operation, But the fact that no one, however strong his oppo¬
sition, has endeavored to evade, or petitioned to set aside this law
as grievous, for more than four years, speaks volumes for its popu¬
larity. Its operation has not restricted commerce, nor retarded man¬
ufactures. That it has produced a decided improvement in the qual¬
ity of imported medicines, even its most violent opponents will admit.
Dr. Bailey, the examiner for the port of New York, states that chemi¬
cal preparations were the first to feel the beneficial effect, and that, as
soon as it was known in Europe that competent examiners stood as
sentries at our sea-ports, and that no article would be entered that
did not stand the test of a certain standard, it would have been folly
in the extreme to have incurred the expense of resisting or of eva¬
ding the law. Hence, every branch of the drug trade was improved.
During the year 1847, over 4,000,000 lbs. of drugs were passed
through the port of New York alone, and taking Dr. Bailey's estimate
of adulterated, damaged and deteriorated articles at one-third the
whole amount, there were over 1,000,000 lbs. imported that year,
unfit for medicinal purposes. In a report made by him recently to
the publishing committee of the New York Journal of Pharmacy, he
states that, from 1848 to 1852, a period of more than three years, he
had rejected 610,000 lbs. of drugs and medicines, embracing
304,185 lbs. of Peruvian bark,
31,838 " Senna,
48
TRANSACTIONS OF THE TENNESSEE
81,121 lbs. Jalap,
65,814 " Sarsaparilla,
1,384 " Scammony,
3,200 oz Quinine,
6,864 Iodine,
3,120 " Iodide Potass.
This drug law went into operation July, 1848. The port of New
York receives about one half of such imports, and Dr. Bailey is its
vigilant inspector. During the first seven months of the working of
the drug law, he rejected 19,989 lbs. rhubarb root • but since that
time, nearly four years, only 6,000 lbs.—during the whole of 1852
not condemning a single pound. Of opium, during the first seven
months, he rejected 3,341 lbs., but from that time up to the date of
his report, a period of two and a half years, only 3,164 lbs. During
1852 he rejected only 950 lbs. while he passed 10,000 lbs. Of gam¬
boge, 1,414 lbs. were rejected within two- months after the passage
of the law, but not one pound since that time. Of gum myrrh, du¬
ring the first nine months he rejected 2,911 lbs., but none since.
The same ^healthful tone has been communicated to all other imported
drugs. It will be thus seen that the law operates well, and only
requires the combined influence of physicians and pharmaceu¬
tists, to secure its ultimate good results. Thus, much has been done
to remedy the evil growing out of foreign importations. But how
stands the case at home ? Could there be any who would avail
themselves of the advantage given them in the absence of the law, to
trample upon public opinion ; ay more ! who would defraud their own
countrymen, by basely adulterating the pure medicines and chemi¬
cals secured to them by the law of Congress ? If so, the law may be
regarded as a protective measure. Just as it is, the domestic adultera¬
tions which are extensively practiced, tend to lessen the price of
American chemicals, to the prejudice of the honest importer. We
say extensively practiced—for it cannot be denied that large estab¬
lishments, in all our eastern cities, are daily in the habit of practicing,
this fraud. An extensive establishment in Brussels, which had, pre¬
vious to the passage of the law, done a large exporting business to
this country, as soon as they found their occupation gone, located a
branch in our midst, for the express purpose of adulterating pure im¬
ported chemicals. And we are told by one who formerly did business
in New York, that it was a common practice in the third story of
the large establishment' in which he was engaged, to adulterate the
pure quinine imported from abroad, half and half, with salacine ;
state medical society.
49
and such practice is still pursued. A case has been cited of a lot
of quinine that had passed the New York custom house after close
examination, thence passed into a New York drug establishment, by
whom it was sold to a firm in Boston. An order having been received
for California, before shipment this lot was again examined, and to
the surprise of all, was found to have imbibed, in its travel from the
custom house to Boston, 25 per cent of mannite.
[ The following circular has been issued from the Treasury Depart¬
ment, since the presentation of this Report to the Society. We need
not apologize for inserting it in this place :
"to prevent the importation of adulterated drugs and medicines.
To Collectors and other Officers of the Customs,
under the act of 26th June, 1848.
Treasury Department, June 4, 1853.
"It being represented to this Department that such embarrassment
has been experienced by officers of the customs, at some of the ports
of the United States, in reference to the provisions of the act of 26th
June, 1848, " to prevent the importation of adulterated and spurious
drugs and medicines," it is deemed expedient, with a view to avoid
future difficulties arising from misconstruction of the law, and to se¬
cure uniformity of practice at the several ports in carrying out its pro¬
visions with precision and efficiency, to furnish you with the addi¬
tional instructions which follow, explanatory and in modification of
the circular instructions addressed to you by the department on the
7th July, 1848.
" To avoid the recurrence of a difference of opinion between the
officers of the customs as to what particular articles of commerce
should be considered drugs and medicines, and as such, subject to
special examination by the special examiner of drugs and medicines,
it is thought proper to state that in conformity with the evident spirit
and intent of the law, it is required that all articles of merchandize
used wholly or in part as medicine, and found described as such in
the standard works specially referred to in the act, must be consider¬
ed drugs and medicines, and that all invoices, therefore, of such ar¬
ticles, in whole or in part, must be submitted to the special examina.
tion of the special examiner of drugs and medicines, before they cam
be permitted to pass the custom house.
"In the examination on entry of any medicinal preparation, the
said special examiner is to unite with the appraiser.
" With a view to afford a reliable guide to the examiner of drags
4
50 TRANSACTIONS OF THE TENNESSEE
and medicines, as well as to the analytical chemist, on appeal, in ascer¬
taining the admissibility of such articles under the provision of the
law founded on their purity and strength, the following list is gives
of some of the principal articles, with the result of special tests
agreeing with the standard referred to in the law, all of which arti¬
cles are to be entitled to entry when ascertained by analysis to be
composed as noted, viz:
" Aloes, when affording 80 per cent, of pure aloetic extractive.
" Assafoetida, whenaffording 50 per cent, of its peculiar bitterresin,
and 3 per cent, of volatile oil.
" Cinchona Bark, when affording one per cent, of pure quinine,
whether called Peruvian, Calisaya, Arica, Carthagena, Maracaibo,
Santa Martha, Bogota, or under whatever name, or from whatever
place ; or
" Cinchona Bark, when affording 2 per cent, of the several alkaloids
combined, as quinine, cinchonine, quinidine, aricine, &c., the bark of
such strength being admissible as safe and proper for medicine and
useful for chemical manufacturing purposes.
Benzoin, when affording 80 per cent, of resin, or
" " 12 " of benzoic acid.
Colocynth, " 12 " of colocynthin.
Elaterium, " 30 " of Elaterin.
Galbanum, when affording 60 " of resin.
" " 10 " of gum and
" " 6 " of volatile oil.
Gamboge, " 10 " of pure gamboge resin, and
" " 20 " of gum,
Guaiacum, " 80 " of pure guaiac resin.
Gum ammoniac" 10 " of resin and
18 " of gum.
Jalap, when affording 11 per cent, of pure jalap resin, whether in
root or in powder.
Manna, when affording 31 per cent, of pure mannite.
Myrrh, " 30 " of pure myrrh resin, and
" 50 " of gum.
Opium, " 9 " of pure morphine.
Rhubarb, " 40 " of soluble matter, whether in
root or powder ; none admissible but the articles known as East
India, and Turkey, or Russian rhubarb.
Sagapenum, 50 per cent, of resin.
" 30 per cent, of gum, and
state medical society.
51
Sagapenum 2 per cent, of volatile oil.
Scammony, 10 percent, of pure scammony resin.
■Senna, 28 per cent, of soluble matter.
''All medicinal leaves, flowers, barks, roots, extracts, &c., not
herein specified, must be, when imported, in perfect condition, and of
as recent collection and preparation as practicable.
" All pharmaceutical and chemical preparations whether chrystaV
lized or otherwise, used in medicine, must be found, on examination,
to be pure and of proper consistence and strength, as well as of per¬
fect manufacture, conformably with the formulas' contained in the
standard authorities named in the act; and must in no instance con¬
tain over three per cent, of excess of moisture or water of chrystalli-
&ation.
" Essential or volatile oils, as well as expressed oils, used in medi¬
cine, must be pure, and conform to the standards of specific gravity
noted and declared in the dispensatories mentioned in the act.
" ' Patent or secret medicines' are by law subject to the same ex¬
amination, and disposition after examination, as other medical prepa¬
rations, and cannot be permitted to pass the Custom House for con¬
sumption, but must be rejected and condemned, unless the special ex¬
aminer be satisfied, after due investigation, that they are fit and safe
to be used for medicinal purposes.
" The appeal from the report of the special examiner of drugs and
medicines, provided for in the act, must be made by the owner or
consignee within ten days after the said report • and in case of such
appeal, the analysis made by the analytical chemist is expected to be
full and in detail, setting forth clearly and accurately, the name,
quantity, and quality of the several component parts of the article ia
question ^ to be reported to the collector under oath <or affirmation.
" On such report being made, a copy of the same will be immedi¬
ately furnished by the collector to the special examiner of drugs and
medicines, who, if the report be in conflict with his return made to
the collector, and he have cause to believe that the appeal and ana¬
lytical examination have not been conducted in strict conformity with
the law-, may enter his protest in writing against the reception and
■adoption by the collector of such report and analysis, until a reasona¬
ble time be allowed for the preparation of his views in the case, and
their submission to this department for its consideration.
James Guthkie,
Secretary of the Treasury."]
52
TRANSACTIONS OF THE TENNESSEE
Allow me to run hastily over the various forms in which medicines
are employed, that I may at once present to your view the readiness
with which such frauds are practiced :
All substances derived from the vegetable kingdom, such as roots,
barks, leaves, woody fibre, flowers and seed, while they do not ad¬
mit, in their original form, of adulteration, are, however, liable to de¬
terioration by age, as well as to admixture with inferior sorts. But
if reduced to the form of powder, they readily admit of such adulte¬
ration. Powdered medicines, moreover, deteriorate by age, as well
as from exposure to air and light. The microscope readily detects a
variety in the starch granules and spiral vessels, while the ineificacy
of the powder, as also its taste and color, will show the effect of age,
and the influence exerted on it by atmospheric agencies and light.
A large portion of the ordinary powders are unreliable, and the pu¬
rity of such, when offered at reduced prices, should be suspected.
But the efforts which are being made to furnish physicians with
select powders are deserving of all praise. Such are the " select
powders" of Haskell, Merrick & Bull, of Hew York, and the "ex¬
tra powders " of Schieflin, Haines & Co., of the same city, besides
others. These medicines are selected of the best quality, and each
substance, before being submitted to the grinding process, is sampled,
and every portion rejected that appears in the least unsound. They
are then ground, and carried through various sittings so as to reduce
them to an impalpable powder. These medicines are then bottled
and encased in paper boxes, so as to prevent any action from
external agencies.
Tinctures may be made of any strength to suit the purse of the
purchaser. They are, moreover, liable to various changes, by which
some become the stronger, others the weaker by age. For this
reason they are very unreliable. Often the alcohol is contraindicated
in the disease for which they are administered, and there is scarcely
a disease that may not be as well treated by the same medicine in
some other form, as the active principle, extract, powder or infusion.
Hot less than 240 tinctures are recognized as officinal, and yet of
these not 20 are in daily use by the faculty. Few physicians use
more than a half dozen in a life-time's practice. The price of these
tinctures will generally afford a criterion of their strength. I have
before me now three prices current, from as many extensive drug
establishments, located severally in Boston, Hew York and Philadel¬
phia. The price of tinctures at these ports of entry, it may readily
be supposed, does not exceed, by a large per cent, the imported costs
STATE MEDICAL SOCIETY.
53
of the articles, and yet the single article of laudanum, is quoted in
the Boston house at 80 cents per lb., in New York at 30 cents, and
in Philadelphia at 50 cents. Such diversity could not exist without
some reason for it, and it cannot be believed that such a great differ¬
ence would be fouud in the original cost of the ingredients, as the
prices current would seem to indicate. The cause is found in the
mode of manufacturing. Opium, not powdered, but in the lump,
with all the leaves and trash that usually accompany it, or it may be
partially exhausted by having had its morphia extracted, or perhaps
in less quantity than directed in the pharmacopoeia, is employed for
this purpose. Let us analyze this tincture with reference to its cost.
Take powdered Turkey opium, two ounces and a half, at a cost of
$1,25, and diluted alcohol two pints, worth 15 cents, to which add
19 per cent, for loss, and for labor in making, and the cost of this
amount, about two pounds, will be $1,60, or 80 cents per pound.
This estimate is made from the selling prices of these articles, in the
quantities ordered by the United States Pharmacopoeia, which should
be the standard for all pharmaceutical preparations! Any deviation
from it should be particularly stated by the dispenser. Standards
are given that the strength of the medicihe may be known without the
least shadow of a doubt. In tinctures, the aleohol is only the vehicle
for holding the desired remedy in a state of minute subdivision, which
may be supposed begins to act only after the peculiar effects of the
alcohol have passed off. Unless, therefore, the pharmaceutist fol¬
lows closely the directions laid down for guidance with reference to
the quantity, form and quality of the drug, strength and quantity of
the- alcohol, time of maceration and subsequent filtration and ex¬
pression, it is almost impossible, at two different times, to prepare the
same tincture of the same strength. And if they vary, what guide
has the medical practitioner ? He guesses at the dose, he aims to se¬
cure certain results, and if disappointed, has no other alternative but
to attribute the failure to the obstinacy of the disease, or the idiosyn¬
crasy of the patient.
Somewhat similar to the foregoing, as uncertain in their strength,
are extracts, which require to be made either by maceration in water,
or in alcohol, or in a mixture of the two fluids. Hence we have
aqueous, alcoholic and hydro-alcoholic extracts. Great care is re¬
quired in their preparation to render them reliable as a form of med¬
icine. As in select powders, it was gratifying to note several praise¬
worthy efforts being made to present the profession with pure pow¬
dered medicines, so in hydro-alcoholic extracts, Tilden & Co., Thorn-
54
TRANSACTIONS OF THE TENNESSEE
as, and others, are preparing a series in vacuo, upon which the most
implicit reliance can be placed. But while these laudable efforts are
struggling for the supremacy, and for favor with the medical men,
others are adopting this form for covering up a multitude of frauds,
which can only be detected through their inefficiency or inertness.
And with such, offered at a cheap price, the country is filled. Hence,
there is a great reluctance on the part of the profession, to the em¬
ployment of extracts.
Chemicals, embracing a large class of remedial agents, belonging to
the organic and inorganic kingdoms, are the most valuable forms of
medicines. But the readiness for effecting adulterations with them
is apparent to all. It is fortunate, however, that science here be¬
stows her kindly aid in readily detecting such impositions—chemical
analysis, and the external characters, especially the crystalline form,
guarding us against these frauds. Here too we have the laudable ef¬
forts of Powers & Weightman, Schieflin, Haines & Co., Bosengar-
ten & Denis, besides others, in the preparation of chemicals in which
the profession can confide, the more laudable because of their greater
importance as medical agents.
This view will suffice to give an insight into the ease with which
frauds are practiced. Thus we see, that while our ports are closed
against impure medicines, busy hands are at wrork glutting the mar¬
ket, and underselling honest manufacturers with cheap adulterated
drugs. The single idea of cheapness has taken such firm hold upon us,
in all our business transactions, having extended itself even to that
class of purchases in which our health and physical well-being are
directly concerned, that any medicine or chemical that has a high
price, is, by a large portion of the medical profession, set aside for
something cheaper. To be dirt cheap, must be a sine qua non with
many of these pill venders—we cannot call them physicians. It is
not by the non-professional alone that encouragement is given to the
sale of cheap medicines. But it is too true, and your committee has
had numerous instances to come under his own observation, that many
of those engaged with us in prosecuting this noble profession, are con¬
tent with the use of unreliable means, so they secure the end for
which they labor—their pecuniary emolument ; the relative pecuniary
value of medicines being of more moment to them than their quality,
Or their own reputation and the lives of their confiding friends. Phy¬
sicians must denounce the vending of impure drugs, if they would
wish the evil remedied. This is a point of far more importance than
that of patent or quack medicines. It is that upon which the honor,
STATE MEDICAL SOCIETY.
55
the success, the respectability of honorable medicine depends. Give
the preference to cheap drugs—discard pure chemicals because they
are costly, and at once honorable medicine is lowered to the level of
quackery. It will be but guess-work at the best, and undeserving of
the high estimate universally conceded to it.
Excuse me, therefore, gentlemen of the medical society, for acting
the part of a medical attendant on this occasion. He is called upon,
not only to point out the nature and extent of the disease of his pa¬
tient, but also to prescribe for its removal. Having, therefore, en¬
deavored to point out the sources of this evil, its character and ex-
tentj it may not be irrelevant to the object of this report, to offer a
few suggestions as to the best mode of remedying it, at least so far
as the medical faculty is concerned. Intelligent pharmaceutists
strongly condemn the practice of such frauds, and colleges of phar¬
macy and pharmaceutical associations are not slow in discountenan¬
cing it.
1st. It is highly important that every physician should be his own
judge of the medicine lie administers. The mechanic knows the tem¬
per and quality of his tools, without possessing a knowledge of their
manufacture. So the physician, though it is not his duty, as it does
not belong to his profession, to compound medicines, or make phar¬
maceutical preparations, yet should be able to prohounce intelligent¬
ly and certainly upon all such used by him. Such information is to
be obtained by actual analysis, and no place is more fitted for com¬
municating such instruction than in the chemical department of our
medical colleges. But your committee has never seen or known any
efforts made to inform the classes in reference to these things. Our
medico-chemical laboratories do not fulfil the purpose for which they
were created. How few among the thousands who tread our medi¬
cal halls, care any thing for the chemical course beyond the recrea¬
tion afforded in witnessing beautiful experiments, being, therefore,
the least useful, and at the same time, most expensive, of all the pro¬
fessorships, while, on the contrary, it should yield to none in interest,
as it does not in importance. To the department of Materia Medica
appertains, in part, the description of the characteristics existing be¬
tween pure and genuine, and impure or adulterated medicines. But
in the department of chemistry, the student should be shown the dif¬
ference by actual analysis, and be taught the mode for detecting
them himself. If possible, specimens of the various powdered drugs,
chemical preparations, tinctures, &c., should be exhibited, and the
analysis of them, in some regular, systematic order, be made a part
56
TRANSACTIONS OF THE TENNESSEE
of the chemical course. Medical chemistry it is which is needed
in medical schools—that branch of the science which relates to
the nature and characteristics of the various medicines employed
in the treatment of disease. Just as the student of agricultu¬
ral chemistry makes himself familiar with the general principles of the
science, and then directs his attention to the analysis of soils and
plants—to the investigation of the nature and habits of the vegetable
world, so as to enable him, in the application of the science to agri¬
culture, to make two blades of grass to grow where but one grew
before ; and just as the student of chemistry, in its application to the
arts, also becomes familiar with the first principles of the science, but
then directs his attention to the influence exerted by, and the appli¬
cation of this science to, the various manufactured productions—so
should we provide for the student of medical chemistry. His object
is not to become a chemist, but to acquire that amount of the gene¬
ral principles of the science, which will enable him to render it sub¬
servient to his success in the profession upon which he is about to en¬
ter. The opinion is, therefore, becoming general, that a reformation
is demanded in the courses of chemical instruction in our medical col¬
leges. Till this be done, our graduates will be unprepared to pro¬
nounce knowingly upon the purity or impurity of medicines. Thus
deficient, they are liable to gross and unpardonable mistakes,, not on¬
ly in using medicines that are unreliable, but also in ordering pre¬
scriptions filled with incompatibles, exposing themselves to the criti¬
cism of every apothecary's apprentice who may get a glance at them.
We do not object to medical students acquiring thorough knowledge
of the sciences, especially of chemistry, but the medical hall is not
the proper field for such acquisition—other institutions are created
for the prosecution of the natural sciences to their fullest extent.
" Ars longa, vita brevis," is an adage that cannot be engraven too
deeply on the mind of every student following the paths of instruc¬
tion. He who assiduously cultivates but one portion of the extensive
domain of science, and therein renders himself a master workman,
who needeth not be ashamed, works out for himself an enduring
name, as well as contributes to the progress of the age in which he
lives. The world is the gainer by possessing such an inhabitant.
The idea then is to adapt the courses of chemical instruction in our
medical schools to the science of medicine, so as to qualify those who
enter upon the practice of this profession, fully adequate to decide
for themselves as to the purity of those agents with which they aim
to overcome disease. Such instruction would tend greatly to remedy
the evil pointed out in this report.
STATE MEDICAL SOCIETY.
2d. Pharmaceutical education is another important means for secu¬
ring this end. It should be regarded as essentia for the business of
dispensing medicines. In this respect, other countries are far in ad¬
vance of our own. In Sweden, no youth can enter as apprentice in
an apothecary's shop, who is under fifteen years of age, and who has
not gone through a school course of history, geography, mathemat¬
ics, Latin and modern languages. In England, to practice pharmacy
requires a diploma from a college of pharmacy. But in our own
country, the monied qualification is the only requisite ; the profits of
the business being the sine qua non with four-fifths of those who en¬
gage in it. But we confidently hope that a brighter day is dawning.
The science of pharmacy is beginning to be regarded as a twin sister
to the science of medicine, and that whatever affects the one, equally
affects the other. This arises from the attempt now being made to
dissever the two professions, and place each upon its proper basis, yet
as auxiliary to the advancement of each other. The colleges of phar¬
macy of New York and Philadelphia, have nobly struggled for years,
to elevate their science to its proper position, and are now beginning
to reap the reward of their labors. In all of our large cities pharma¬
ceutical associations are being formed, and during the last year, by
the united action of all such associations throughout the country, the
National Pharmaceutical Association was organized. It is gratifying
to your committee, engaged now as he is, exclusively in promoting
this department of honorable medicine, though claiming paternity
from the household of JEsculapius, to bring to the notice of his medical
brethren, the efforts of pharmaceutists to elevatp their profession to its
proper position, by requiring higher qualifications for membership in
their associations'than merely the ability to conduct ably a drug estab¬
lishment. The pharmaceutist stands between the physician and his
patient. As the compounder of his prescriptions, the physician's suc¬
cess is, to a certain degree, in his hands. Such a responsible position
requires a thorough pharmaceutical as well as practical training. It
seems to be an inevitable result that there should be a distinction
made between the apothecary and the druggist—the former standing
between the physician and the latter. He, the apothecary, would be
accountable for all medicines compounded and dispensed, and patro¬
nage should be extended to no one unless he had a certificate of
graduation from some college of pharmacy.
General chemistry, theoretical and practical pharmacy, materia
medica and medical botany, are all essential for the proper practice
of pharmacy—years of practical training in a drug store cannot be
58
TRANSACTIONS OF THE TENNESSEE
substituted for this course of instruction. It is true, our assistants
may become expert as salesmen, and be able to pronounce an opinion
respecting the character of the ordinary medicines; but the daily
routine of duties in ohr establishments is too imperative to allow of
any systematic or regular instruction, and hence, especially in our
western country, there is a deficiency of instruction in pharmacy.
We hope, however, that the day is not far distant when the college
of pharmacy will take its place along side of the medical hall, or
when such advantages will be given to students of pharmacy in our
medical schools, by the establishment of professorships of theoretical
and practical pharmacy, as will induce them to qualify themselves
properly for their responsible duties. Such professorships might be
instituted as collateral, not as indispensable for every member of the
institution. There is no doubt but that many would avail themselves
of such advantages in connection with the courses on Chemistry and
materia medica. Pharmaceutical education is, therefore, another
important means for remedying this evil.
3d. Foreign adulterated and deteriorated medicines being declared
contraband by our national Congress, it devolves upon our state legis¬
latures to devise some means by which home adulterations may be
arrested. More, however, is to be gained by popular opinion, and
by pharmaceutical and chemical education, than by any other means.
Our legislatures may pass laws, inflicting heavy penalties upon all
who may adulterate, or knowingly sell adulterated or deteriorated
medicines, but who is to be judge in such cases ?
Regarded in any light, the subject of this report is one of great in¬
terest. It involves more than the preservation of our estates—the
honor of man is implicated in it—his life, and the consequent happi¬
ness and welfare of families. Was every medicine strictly pure, and
every physician fully competent to his duty, the honorable science of
medicine would not be an uncertain profession. Quacks and their
nostrums would no longer find a resting place, for they would be re¬
garded as monsters
" Of such frightful mien,
That to be hated needed only to be seen."
The earth teems with a multitude of medicinal agents, presented
pure to us, for the cure of disease, from her fruitful bosom. As We
derive from it the elements of sustentation, granted so exuberantly
that it is only necessary to put forth our hand and pluck and eat—
so for every ill there is afforded a remedy—for every disease a cure.
Medicinal agents are the gifts of heaven. Science and art, the hand-
STATE MEDICAL SOCIETY".
59
maids of religion, apply them to the noble purposes for which they
are designed.
These, gentlemen of the Medical Society, are the means which
have been perverted by designing men, for selfish purposes—and it
devolves upon you, by uniting your influence with others engaged in
the same honorable mission, to put forth your energies for remedying
the evil.
Nashville, Tenn., May 4th, 1853.
REPORT OF COMMITTEE ON CONTINUED FEYERS.
By Dr. W. P. Jones, of Nashville, Chairman.
The Committee, to whom was referred " The History of Continued
Fevers of Tennessee, their varieties, semiological, anatomical, and
other characteristics/' beg leave to report:
That as soon as practicable, after their appointment, they issued a
circular, embodying the prominent points of observation, and sent
probably five hundred to the address of medical men in different di¬
visions of the State ; in addition to which, we have individually so¬
licited the co-operation of friends, and your chairman alone, has writ¬
ten more than a hundred private letters, urging honorable members
of the profession to furnish the desired information. We however
regret to say, that few have regarded our solicitations ; indeed, with
the exception of ten or a dozen communications, we are wholly with¬
out manuscript authority upon which to base a report.
If, under these circumstances, therefore, you think proper to con¬
tinue your present committee, we hope, by the next annual meeting,
to be able to meet the reasonable expectations of the Society.
60
TRANSACTIONS OF THE TENNESSEE
REPORT OF COMMITTEE ON THE HISTORY OF EPI¬
DEMIC DISEASES.
By Dr. E. B. Haskins, of Clarksville, Chairman.
Your Committee, to whom was entrusted the honor ctf writing the
History of Epidemic Diseases in Tennessee, beg leave to offer the
following brief report of their labors :
At an early date, after the adjournment of the meeting of the So¬
ciety last May, letters were addressed to the post masters of the
county seats of all the counties in the State, asking the names and
address of two or three of the most distinguished physicians in their
respective counties.
To these letters a very ready and general response was made.
One physician in each county was selected, out of the many thus pre¬
sented, to whom was sent a printed letter, asking his aid by furnish¬
ing the materials of his county—with the emphatic request to return
the letter if he declined the assistance sought.
But two of these letters have been returned. It will, therefore,
appear that one physician in each county in the State, with but two
or three exceptions, engaged to assist your committee in their labors,
by forwarding the facts illustrating the history of epidemic diseases
in his county. Besides their special arrangements for the accumula¬
tion of materials, your committee published an Address to the Physi¬
cians of Tennessee, in the Nashville Journal of Medicine and Surgery,
and in the East Tennessee Record of Medicine and Surgery, begging
every one in possession of facts useful to the committee, to report
them to either member. Private letters, accompanied by the printed
circular, were also addressed to a few distinguished physicians, who
are, and have been, editors of medical journals in the West, asking
information with regard to any publications touching the subject mat¬
ter of the committee's research, which may have appeared during
their editorial career.
After so extensive preliminary steps, it is with deep regret that
your committee have to acknowledge that they have, as yet, received
no materials at all adequate to the important task imposed upon
them. But three communications have been received—one from Dr.
W. D. Haggard, of Gallatin, one from Dr. Thomas Lipscomb, of
Shelbyville, and one from Dr. Conn, of Pelham, Grundy county.
STATE MEDICAL SOCIETY. 61
Having so signally failed in their efforts ; and on reviewing the
ground-work of their labors, discovering so little in the plan of their
proceedings to be amended, your committee request that their report
be received, and they be relieved from further duty on this subject.
CASE OF CEREBRAL DISEASE.
Read before the Medical Society of Tennessee. By M. Ransom, M. D., of
Rutherford county Tennessee.
Aug. 9th, 1852. Saw, in consultation with Dr. S , Julia H.,
aged about ten years.
About the 20th of last month, after complaining for a day or two
of headache, she was very suddenly attacked with partial paralysis
of the left side of the body. She soon had high fever, with violent
pain of the head and some delirium. By mercurial cathartics, refrige¬
rant diaphoretics and local depletion, she was partially relieved, but
again grew worse. About eight days ago she began to have clonic
and tonic spasms of the muscles, generally, which have continued
paroxysmally to this time. Some of the muscles of the lower limbs
are permanently contracted. The left leg is rigidly extended, while
the right is closely drawn to the body, and she seems to suffer excru¬
ciating pain when any attempt is made to change their position. The
right pupil is natural, while the left is widely dilated. Has not been
able to articulate since the 6th ; swallows with much difficulty ; skin
hot and dry ; pulse 120 and rather small; tongue coated yellow ;
bowels sluggish ; is slightly ptyalized.
Treatment.—A blister to the whole occiput, and ammonia linament
to the spine ; to take | oz. of castor oil, and afterwards 1 gr. of calo¬
mel three times a day, or as often as may be necessary to keep up
ptyalism. A teaspoonfull of spirits of nitre every two hours.
11th. Less fever ; much the same otherwise. Blister drawn well,
spine red and sore ; bowels moved only once. Ordered purgative
enema ; continue calomel and add camphor to spirits of nitre.
18th. Paroxysms or spasms not quite so frequent or long contin¬
ued j castor oil and injections have failed to move the bowels; pty-
TRANSACTIONS OF THE TENNESSEE
alism increasing. Suspend the calomel, and give | a drop of croton
oil in | oz. of castor oil, every two hours, until bowels are moved,
assisting it with enema.
15th. After taking four doses of the purgative, the bowels were
freely moved. More quiet; very little clonic spasm now, but the
tonic contractions remain the same. Left side is completely power¬
less. There is now such an acute, morbid sensibility of the surface
of the limbs, that she cannot bear the contact of the lightest cover¬
ing. Reapply the blister, extending it over the cervical spine.
18th. No fever ; swallows better ; bowels easily moved. Has in¬
continence of urine. Dress the blister with mercurial ointment, and
keep the bowels open with oil.
21. Improving in general health. The paroxysms of spasm have
entirely subsided, but the limbs remain contracted and paralyzed as
before. Reapply blister, and give bichloride of mercury three times
a day, (one twentieth gr.)
25th. The morbid sensibility of the surface of the limbs is so
far diminished as to allow of their being covered. Has a bleeding
sore on the sacrum ; incontinence still continues. Continue the mer¬
cury and 10 drops of tincture of cantharides, three times a day.
Sept. 1st. General health tolerably good ; she recovered her speech
imperfectly on the 21th ; can now protrude the tongue, the left side
of which is palsied ; is relieved of the incontinence ; sore on the sa¬
crum soon healed after removing the pressure. Continue same treat¬
ment and iodine and mercurial ointment to the old blistered surface.
6th. General health good; is gaining flesh rapidly, but the im¬
provement in paralysis and muscular contraction very slow. I should
have mentioned before that there has as yet been no want of sensi¬
bility of any part of the surface. Take in addition to the bichloride
of mercury, one twentieth gr. of strychnine, three times a day.
14th. After taking the strychnine two or three days, it produced
a trembling and wildness, that induced the parents to discontinue it,
but since then, the improvement has gone on much more rapidly than
before. The right leg can now be extended. Continue it in one
twenty-fifth gr. doses. Frictions to the spine and limbs.
Nov. 1st, The patient has gradually acquired tolerably good use of
all the limbs, but the left foot remains drawn backwards so as to im¬
pede her walking. The left pupil has not yet contracted to its usual
size. Discontinue medicine except laxatives, and keep up the frictions,
March 30, 1853. Patient has been apparently well for three
months. Any thing causing an afflux of blood to the head, as being
too long in a stooping position, causes the left pupil to dilate.
state medical society.
63
This case is interesting as one exhibiting at once the various effects
of a morbid condition, in a different degree, of opposite sides of some
portion of the nervous centres, as well as affording additional evi¬
dence of the value of mercury in the active stage of such affections,
and the efficacy of strychnine in restoring nervous energy. Although
the manner of attack would lead us to suspect hemorrhagic extrava¬
sation, yet the prominent muscular contractions and other symptoms,
seem to point out inflammatory softening as the true pathological cause.
OPERATION FOR FISTULA IN ANO.
Reported by Dr. J. L. Park, of Franklin.
In lieu of the case I was appointed to report, having met with
none of sufficient peculiarity, or in which a departure from the ordina¬
ry principles or modes of practice was demanded, by which I could in
any degree expect to interest the Society, but at the same time de¬
siring to manifest my willingness to comply, as far as in my power,
with the requisitions of duty assigned me, I beg leave to present, for
the inspection of the members, an instrument, or rather a set of instru¬
ments, the invention of which, some difficulties in the performance of
an operation, suggested to my mind. I allude to the operation for
the cure of Fistula, in ano, and think some of the inconveniences at¬
tending the operation for its radical cure, whether by the knife or lig¬
ature, may be obviated by their use. The subject was that of a stout
negro man, living in the country, upon whom the ordinary operation
of laying open the part to the bottom of the fistula, with the bistoury,
had been twice or thrice performed, by different surgeons, and still,
when the wound had healed, the fistula remained, or another formed.
I presume the failure of cure was owing to the pledget of lint passing
out with the first and every succeeding effort at defecation, and not
immediately or properly replaced and kept between the lips of the
wound, until full suppurative inflammation was established. Perhaps
there may have been, in the deep-seated cellular tissue, ramifications
which could not be traced with the probe.
Negroes on a plantation, or those whose circumstances will not per-
64
TRANSACTIONS OF THE TENNESSEE
mit them to be near a physician, are, of necessity, not so secure of a
complete cure. The failure of success in this case, by the knife, and
circumstances unfavorable to strict attention, induced me, with the
concurrence of another physician of greater experience than myself,
to attempt the ligature, although we were not ignorant of its con¬
demnation by a great portion of the profession. We deemed that
particular circumstances might render the ligature proper, and those
of this case were of such a nature. The result has been entirely, sat¬
isfactory, and proved the propriety of the course.
The direction of the fistula was nearly parallel with the rectum,
and at the depth of one and a half inches, the part requiring inci¬
sion to communicate with the bowel, was near half an inch. The
perforation was made with a stylet, with cutting edges, and carrying
a ligature near the point. After penetrating the bowel, I had con¬
siderable difficulty in seizing and extracting the ligature, on account
of the powerful spasmodic action of the sphincter, deadening the
tact of the guiding finger, and the intestinal mucus membrane inter¬
fering with the forceps. It then occurred to me that these difficul¬
ties might be obviated by such instruments as I now exhibit.
They are roughly made, the longest being moulded of the ordinary
syringe metal, and consists of a conical tube, resembling a speculum,
closed at the apex, and may be very well applied to that purpose,
having a large oval or elliptical opening in the side. The calibre of
the cone is sufficient to admit the forefinger, and the perforation cor¬
responding to the tactile portion of it, and of such length and width
as to permit free exploration. The extremity of the perforation is
continued towards the apex as a slit of a line in width E and half an
inch long.
The second instrument is a stylet, with disconnected and enclosed
in a canula. The point has cutting edges, and an eyelet for carrying
a ligature.
The third consists simply in a different application of the sheath to
the ordinary curved bistoury. The guard being so applied as to be
more easily thrown off than that generally employed. The cone be¬
ing passed up the rectum, prevents the paralizing effect of the sphinc¬
ter from being exerted upon the finger, at the same time that the
large perforation in its side does not embarrass its motion, or prevent
its adaptation to the extremity of the probe or director, and ascer¬
taining where the point of the bistoury or stplet should, or has pene¬
trated the bowel. The finger may then be withdrawn a little so as
to permit the point of the instrument to be pushed forward into the
STATE MEDICAL SOCIETY.
65
cone and engage in tlie slit, by which the knife will be firmly held
and Strengthened, so that, on the withdrawal of all together, the
necessary incision will be completed, without risk of the surgeon's fin¬
ger being wounded. It is important to have an additional support
to the bistoury, especially if we use the closing shell-handled ones.
Sufficient force can scarcely be exerted upon their handles to make
sections with the requisite precision. If it is desirable to carry a
ligature, the disconnected points of the stylet, wrth the loop of the
ligature, will be engaged within the slit, and withdrawn within the
cone ; or the loop can he more readily seized by the forceps, the cone
acting the part of the speculum.
The advantages of their employment over the ordinary mode of
cutting upon the finger, may be thus enumerated :
X. The conical tube prevents the spasm of the sphincter from em¬
barrassing the finger, and consequently facilitates the speedy accom¬
plishment of the operation, thereby curtailing the suffering of the
patient.
2. At the same time that it ensures the thorough section of the
parts, it does not endanger the cutting of the surgeon's finger.
3. It imparts support, strength and firmness to the knife.
4. It makes easy the seizure of the loop of the ligature, as the
forceps may then be directed by the eye.
5. In case of cutting an artery requiring ligature, it would be ea¬
sily accessible through the large perforation in its side.
6. The stylet point and eye being detached from the shaft, will,
with the loop, be withdrawn within the cone without risk of injuring
the soft parts.
7. The advantage of the different shield from that generally em¬
ployed, is in its more ready detachment without drawing back the
blade, which, if withdrawn far enough to detach the shield, may en¬
gage the soft parts without reaching again the bottom of the fistula,
thereby leaving such a cul de sac as may determine the formation of
another fistula.
66
TRANSACTIONS OF THE TENNESSEE
CASE OF FALSE ANEURISM.
By Dr. J. W. Knight, of Rutherford County.
On tlie llth of of November, 1851, I was summoned to see Mr. T.
"W., aged about thirty-seven years, of large frame, and had been un¬
usually robust, but in consequence of excessive use of intoxicating
drink, his constitution had become much impaired. He had been the
subject of an aneurismal tumor on his left leg for upwards of twenty
years.
The tumor is situated about midway between his ancle and knee,
on the posterior portion of his leg, and was caused by an accidental
discharge of a musket. He informed me that he had suffered no par¬
ticular inconvenience from it until a few days before I saw him. It
first commenced paining him while riding horseback. The friction
produced by the stirrup leather, and the unfavorable position of the
limb while riding, together with his system being fully saturated with
his favorite beverage, all tending to aggravate the condition of his in¬
flamed limb.
The tumor was somewhat larger than formerly, and very tender to
the touch. The leg measured nineteen inches in circumference after
the tumor had been lanced, the sound limb measuring only ten inches
about the same place.
He could not allow the limb to be handled without excruciating
pain. The skin on the tumor had a gangrenous appearance ; pulse
130 and feeble ; had not slept any for several days and nights ; tongue
coated, bowels rather torpid. I could detect no aneurismal thrill.
Mr. W. informed me that it had pulsated, but not recently.
Treatment.—After examining the tumor carefully, I was led to in¬
fer that it contained pus—applied the tourniquet and drew off a pint
of pus and blood. The blood had partially coagulated. He now ex¬
pressed himself as being much relieved of pain, but grew sick and
faint. Gave a little camphor julep, &c. The limb was so much in¬
flamed and so sensitive, that he could not bear the bandage. Ap¬
plied warm wheat bran and charcoal poultices, and put the limb on
an inclined plane. Slackened tourniquet, and let it remain around
the limb ; gave mild purgatives and an anodyne at night, to procure
rest, &c.; gave refrigerating diaphoretics as a febrifuge.
STATE MEDICAL SOCIETY. 67
Visits on the 19th, 20th, and 21st.—Fever continues very high ;
pulse feeble, and his condition pretty much the same. Tumor con¬
tinues to discharge pus and blood.
Visits on 22d, 23d, and 24th.—No material alteration, except that
lie is growing more feeble. His habits being so very bad, and be¬
cause of his great liability to hemorrhage, at any time, I was of the
opinion that it would be safer to amputate his leg, when his condition
would allow of it. My partner, Dr. Richardson, being absent, Drs.
Wendel and Avent saw him with me, and were of the same opinion.
Mr. W., however, objected to the amputation, and said he would
rather risk the consequences. I was called to see him in haste on
the morning of the 29th, before day.
Thinking his limb almost well, he had taken off the tourniquet, and
had been moving it so as to cause excessive hemorrhage, which was
likely to prove fatal. The hemorrhage was evidently arterial. The
tourniquet was again applied, the limb placed on an inclined plane,
and kept in that position until the inflammation had subsided. I visi¬
ted him December 1st, 6th and 9th, and advised him to Wear a lace
stocking. The last accounts, which were five or six months after my
last visit, he was cutting cord-wood on the Mississippi.
I am aware that the usual mode of treating aneurism is by ligation
and compression. But owing to the limb being in such a diseased
state before subjected to treatment, I think the application of a liga¬
ture would have been hazardous. Compression, however, was made,
to some extent, on the femoral artery, but the limb was so painful
he could not bear it to that degree that would have been desirable.
CASE OF FALLOPIAN PREGNANCY.
By Dk. Smith Bowlin, of Bellbuckle Depot.
I have just returned, accompanied by Dr. D. H. Johnson, from
an examination of Mrs. Wiggs, from whom I have learned the fol¬
lowing history. She was born of healthy parents, was robust and
of a good constitution—menstruated at the age of fourteen, and
continued regular until the age of twenty two, at which time she
married. In October, ten months after her marriage, she was at¬
tacked with excruciating pain ( supposed to be of labor) across the
loins, hips and lower part of the abdomen, which was only partially
relieved, for twenty four hours, by copious bleeding.
68
TRANSACTION'S OF THE TENNESSEE
The pain then increasing, an old and very respectable midwife was
then sent for, who failed to deliver her ; Dr. Wm. Norton was im¬
mediately summoned. Dr. Norton confirmed the opinion of the
midwife, viz : that her time was not out. Another old and experi¬
enced midwife was sent for, who gave it as her opinion that Mrs,
"W. was not in the family way at all, and that there was something
in the uterus, she knew not what. Mrs. W. continued very unwell
from October 25th, 1830, to February, 1831, during two months of
which time, she was unable to lie down at all, but was compelled to
remain in a sitting posture, because of the severe pains, together
with an alarming and constant discharge from the uterus, which was
dark colored, very offensive to the smell, and evidently saturated
with flesh. February 28th, 1831, the disease having now assumed
an alarming aspect, Dr. Beckton, of Kutherford county, was called
in, who, after making the necessary examination, decided that it was
a clear case of Fallopian Pregnancy, and the only one he ever saw
of the kind. Dr. Beckton possessing no means of relief, left her
case to the powers of nature. Soon after this she began to improve,
the enlargement of the abdomen began gradually to subside, the
pain in the loins, hips and lower part of the belly became less severe,
the discharge from the uterus began to diminish, and was less offen¬
sive. Her health continued to improve until menstruation was again
regularly established, which continued until interrupted by preg¬
nancy.
In July, 1832, Mrs, W. was delivered of a fine healthy child;
since which time she has had four living children, and has miscarried
once. There were thirteen years between her last. Twenty two
years have now elapsed since this singular occurrence. Mrs. W. is
forty five years of age, and enjoys a tolerable degree of health, with
the exception of pains more or less severe, nearly all the time, in the
right iliac region, where the bones of the child are deposited, and may
be plainly felt by external examination. I have carefully examined
Mrs. Wiggs, and there cannot be a reasonable doubt as to the na¬
ture of the case. It mast be Fallopian Pregnancy.
Having met with but one similar case on record, and that was by
Dr. Baird I believe, I have selected this case to report to the
Medical Society of Tennessee, hoping it would be acceptable to the
members of our honorable profession, and furnish another well attes¬
ted case of Fallopian Pregnancy to the medical history of onr
country.
state medical society.
69
ACT OF INCORPORATION.
AN ACT TO INCORPORATE THE MEDICAL SOCIETY IN THE STATE
OF TENNESSEE.
As health is universally acknowledged to be essentially necessary
to the happiness and prosperity of society, and its preservation and
recovery are essentially connected with an intimate acquaintance with
the animal economy, and the properties and effects of medicine ; and
as institutions formed on liberal principles, cherished by an intelligent
community, and patronized by law, are eminently calculated to en¬
courage the propagation and dissemination of such knowledge, there¬
fore,
Section 1.—Be it enacted by th<z General Assembly of Tennessee,
that there shall be appointed, by a resolution of this General Assem¬
bly, a sufficient number of learned and intelligent practicing physi¬
cians in this State, who, when so appointed, are hereby constituted
and formed into a body politic and corporate, by the name of the
*' Medical Society of the State of Tennessee," and they, and such other
persons as said Board may hereafter elect, in the manner prescribed
by this aet, and their successors, shall continue to be a body politic
and corporate, until the year 1860.
Section 2.—Be it enacted, that the members of the Society may,
from time to time, elect a President, Vice President and Secretary,
and such other officers as they may think necessary and convenient,
and the members of said Society shall have power to determine the
respective duties of the several officers, the length of time they shall
hold their respective offices, also to authorize their President, or some
other person, to administer such oaths to those officers as the Society
shall think proper, not repugnant to the laws of this State, or of the
United States, and shall have a common seal, and power to alter and
renew the same at their pleasure.
Section 3.—Be it enacted, That the members of said Society may
sue and be sued, in all actions, real, personal and mixed, and prose¬
cute and defend the same to final judgment and execution, by the
10
transactions OF the tennessee
name and style of the "Medical Society of Tennessee."
Section 4.—Be it enacted, that said Society may elect, under such
regulations as it may adopt, such persons as may be thought worthy
practitioners of Medicine and Surgery, to be members thereof, and
such person o>r persons, so elected, shall be entitled to all the privile¬
ges and immunities of said Society, provided that he or they shall,
within one year from the time of his or their election, sign the By-
Laws and regulations of said Society, or otherwise in writing signify
his or their assent thereto ; and shall have power to expel any of its
members for misconduct.
Section 5.—Be it enacted, That said Society shall have power and
authority to enact such laws and regulations for the government of
the same, as are not repugnant to the constitution and laws of thig
State, or of the United States, and to annex reasonable fines and
penalties, not exceeding fifty dollars, to be sued for and recovered
by said Society, for their use and benefit, in any court of law in this
State ; and also to fix the times and places of the meetings of said
Society, which shall be at least once in each year.
Section 6.—Be it enacted, That the first meeting of said Society
shall be held in the town of Nashville, in this State, on the first Mon¬
day in May, 18E0.
Section T.—Be it enacted, That the " Medical Society of Tennes¬
see," so soon as they may meet and organize themselves, shall pro¬
ceed to elect seven persons, who reside in Middle Tennessee, not more
than two of whom reside in the same comity, who shall constitute a
board of " Censors for Middle Tennessee," and also, in like manner,
elect a board of " Censors for East Tennessee and the Western Dis¬
trict."
Section 8.—Be it enacted, That the persons thus elected to con¬
stitute said Boards of Censors, shall hold their appointment for the
term of one year from the time of their election, and until others shall
have been elected to supply their places ; they shall meet at such times
and places as they may agree upon, at least twiee in each year, and
when so convened, they shall proceed under such regulations as shall
be adopted by the Society, to examine any persons who may present
themselves for such examination, touching their skill in the practice
of Medicine and Surgery ; and if, on such examination, the Board of
Censors shall deem such candidate sufficiently skilled in the science
and practice of Medicine and Surgery, they shall grant to such can¬
didate a license to practice the same in the State of Tennessee.
Section 9.—Be it enacted, That no qualification shall be deemed
state medical society.
71
necessary to entitle a candidate to examination, except that he shall
be twenty-one years of age, and of good moral character.
Section'10.—Be it enacted, That if either of the Boards of Cen¬
sors shall obstinately refuse to examine any candidate having the
above qualifications, each member who shall be present at the time
of such refusal, and shall concur therein, shall be fined in a sum not
exceeding Five Hundred Dollars, to b$ sued for and recovered by
such person or persons so refused, in any court of law in this State,
for his own use and benefit.
Section 11.—Be it enacted, That the Medical Society of Tennes¬
see shall have power, at any regular meeting, to levy such contribu¬
tions . on its members as shall be thought necessary to effect any of
the purposes of its establishment, and shall have power and authority
to collect the same in any court of law in this State.
Section 12.—Be it enacted, That any one of_the Censors appoint¬
ed under the provisions of this act, shall have power and authority
to grant a temporary license to any person or persons, to practice
Medicine and Surgery, until a regular meeting of said Board of Cen¬
sors, after which time the said temporary license shall be void.
Section 13.—Be it enacted, That said corporation shall, at all
times, be subject to such rules, regulations and restrictions, as may
be thought necessary, and imposed by the General Assembly of this
State.
Passed January 9th, 1830.
EPHBAIM H. FOSTER,
Speaker of the House of Representatives.
JOEL WALKER,
Speaker of the Senate.
BY-LAWS
OF THE MEDICAL SOCIETY OF TENNESSEE.
Article 1.—The Society shall convene annnally, on the first Mon¬
day in May, at Nashville.
Article 2.—The officers shall consist of a President, Vice Presi¬
dent, a Recording Secretary, Corresponding Secretary, and a Treas¬
urer.
Article 3.—Twenty-five members shall constitute a quorum to
transact business.
Article 4.—The officers shall be chosen by ballot, and continue in
office for the term of two years, and in case of a tie, the presiding
officer shall give the casting vote, and the majority shall elect.
Article 5.—The President shall preside at all meetings, preserve
order, and regulate the debates, state and put questions, agreeably
to the sense and intention of the members •; he shall have power to
fine any member for disorderly conduct, in a sum not exceeding Five
Dollars, for each offence ; he may, with the concurrence of the Vice
President, call a general meeting of the members at any time, inter¬
vening the periods fixed for the established meetings, whenever he
may think that the interests of the Society shall require a special
meeting, of which one month's notice shall be given in some one of
the newspapers of Knoxville, Nashville and Jackson.
Article 6.—In the absence of the President, his duties shall de¬
volve on the Vice President, and if neither of them be present, a
presiding officer, fro term., shall be appointed, who shall perform the
duties of a President.
Article ?.—It shall be the duty of the Recording Secretary to
attend each meeting of the Society, call over the names of the mem¬
bers, and take down the minutes, which shall be read at the next
meeting ; he shall keep a list of the members admitted, also a list of
the names and residences of all those persons who shall have received
a license from the Board of Censors.
Article 8.—It shall be the duty of the Corresponding Secretary,
to write and answer all letters on behalf of the Society, to manage
all matters of correspondence, and to make a faithful record of such
communications as this Society may think worthy of being preserved.
transactions of the tennessee
Article 9.—The Treasurer shall receive all donations, and collect
all the contributions arising from such laws and regulations as the
Society shall from time to time make ; he shall likewise keep all the
moneys and securities belonging to the Society, and shall pay all or¬
ders signed by the President, Vice President, or presiding officer, for
the time being, which orders shall be his vouchers for his expendi¬
tures.
ADMISSION OF MEMBERS.
Article 10.—Any medical gentleman who shall be proposed as a
member of this Society, may be admitted by the vote of two-thirds
of the members present. On admission, he shall sign the Constitu¬
tion and By-Laws, and pay into the hands of the Treasurer such sums
as may annually be paid by the members of the Society.
Article 11.—No person residing within the limits of the State,
shall be admitted as an honorary member ; but any medical gentle¬
man residing without the limits of the State, having been proposed
and satisfactory reasons given why he should be admitted, may be
elected by the vote of two-thirds of the members present.
CENSORS.
Article 12.—The Medical Boards of Censors shall be chosen by
ballot.
Article 13.—It shall be the duty of each of the Boards of Cen¬
sors to subject the candidates for licenses to an examination on the
following branches of the profession, viz : Anatomy, Physiology, Pa¬
thology, Chemistry, Materia Medica, the Practice of Medicine, Sur¬
gery and Midwifery—except when the candidate presents such testi¬
monials of qualifications as, in the judgment of the Board, may pre¬
clude the necessity of examination.
Article 14.—Not less than five Censors shall constitute a quorum
of either Board. If five cnly are present, one vote may reject a
candidate ; if more are present, two negative votes are required to
reject.
Article 15.—The Dean of each Board of Censors shall keep a
record of its proceedings, and from time to time transmit the same,
with the fees by him received, to the Recording Secretary.
Article 16.—The Licentiate shall be furnished by the Censors
with a license, printed on parchment, signed by themselves, the Presi-
state medical society.
15
dent and Recording Secretary, and stamped with the seal of the So¬
ciety, after the following manner :
"We, the subscribers, Censors of the Tennessee Medical Society,
duly appointed and authorized, have examined A. B. of C , in
the county of D , a candidate for the practice of Physic and Sur¬
gery, and having found him qualified, do approve and license him as
a Practitioner in Medicine, agreeably to the law in that case made
and provided."
Article 11.—The President shall have authority to fill up any and
every vacancy that may occur between the regular meetings of the
Society, by the concurrence of the members of the Board in which
such vacancy or vacancies may occur.
Article 18.—The President or presiding officer shall, at each an¬
nual meeting, appoint an Orator, whose duty it shall be to deliver a
suitable address, at the next annual meeting, on some subject apper¬
taining to the Science of Medicine, Natural History, or Botany, un¬
der a penalty of Twenty-five Dollars.
Article ID.—On motion, at any regular meeting, a member may
be expelled by a vote of two-thirds of the members present, previous
notice, with specifications of the charge having been given him by his
accuser or accusers, three months before the meeting at which such
motion shall be made ; provided, nevertheless, that when any charge
shall be made by one member of the Society against another, the
accused shall be at liberty to call upon any five members of said So¬
ciety, most convenient to the parties, who shall, on reasonable notice,
examine into said charge, and if deemed of sufficient importance,
shall report the same to the next meeting of the Society, otherwise
finally dispose of the same in such manner as they may deem just and
proper.
Article 20.—The form of oath administered by the presiding offi¬
cer of the Society, or any Judge of the State, shall be in the follow¬
ing words :
"I, A. B., of the county of C , and State of Tennessee, do
hereby solemnly affirm that I will faithfully, truly and impartially,
perform the duties assigned me as prescribed by the act of the Legis¬
lature and the by-laws of the Society, to the best of my knowledge
and abilities."
Article 21.—No one of the foregoing by-laws shall be altered or
amended without the concurrence of two-thirds of the members pres¬
ent.
76
TRANSACTIONS OF THE TENNESSEE
LIST OP MEMBERS
FROM THE ORGANIZATION OF THE TENNESSEE MEDICAL SOCIETY IN 1830,
TO THE PRESENT TIME, 1853.
James Roane
James King
James M. Walker
L. P. Yandell
Boyd McNairy
Wm. R. Rucker
B. J. Bledsoe
John B. Hays
S. S. Porter
J. W. P. McGimpsey
A. C. Gillespie
Joel C. Hancock
P. E. Becton Jr
A. Gillespie
J. A. Blackmore
Elmore Douglass
D. M. Porter
Wallace Estill
Samuel Watkins
James A. Wilson
E. R. Anderson
Samuel Hogg
W. W. Topp
Daniel C. Dixon
Felix Robertson
William G. Dickinson
John Maxey
James Young
Peyton Robertson
Thomas R. Jennings
Ferdinand Stith
F. F. Reid
Seth W. Bell
Allen J. Barbee
John H. Crisp
John H. Kain
Daniel L. Saunders
Samuel Ridley
Alexander F. McKinney
Henry E. Turner
Robert Nicholson
John Temple
Patrick D. Neilson
John H. Mar able
John C. Hicks
T. B. Dudley
E. M. Patterson
Syd Smith
Felix Ewing
A. B. Ewing
John Y» McKinney
Charles McKinney
David F. Brown
Luth Biglow
John Travis
William P. Goodwin
Joseph C. Strong
M. D. L. F. Sharpe
J. M. Sitler
George Keeling
John F. McKither
Thomas H. Reid
George Snyder
Daniel M. Gwinn
J ames W. Hoggatt
Elijah Thompson
Lewis W. Grier
William M. Gwinn
William W. Lea
Erasmus D. Fenner
Robert Fenner
J. G. M. Ramsey
William P. Lawrence
William Norton
John R. Wilson
Thomas A. Anderson
Archibald Thomas
C. R. Jamison
William W. McG ee
George Thompson
Robert Stone
B. M. Hughes
STATE MEDICAL SOCIETY.
William Walker
Hugh Walker
Donald Mcintosh
E. N. Field
James Gray
M. D. Gowen
Charles Pusgley
William E. Herald
W. J. Dewith
John Waters
John Irwin
John J. Franklin
William T. Baskette
Evans Mabry
Thomas J. Donoho
William M. Yandell
Thomas F. Watson
Beverly Miller
Z. T. Harris
J. H. Robinson
Thomas J. Kennedy
Robert Turner
W. S. Webb
R. Higginbotham
A. H. Treadway
P. H. Mitchell
D. N. Sanson
S. C. McWhirter
M. D. Dixon
H. E. Anderson
H. Brooks
V. F. Crutchfield
George D. Crosthwait
Alfred Paine
J. C. Wilborn
N. C. Taylor
J. B. Doherty
John H. Campbell
Henry Y. Webb
M. H. Scales
Philip F. Nor fleet
J. N. Esselman
Joseph J. H. Pugh
E. Wright
M. M. Corch
William P. Sayle
John H. Atkinson
Thomas C. Black
J. P. Wagner
John C. Gooch
Preston W. Davis
Daniel McPhail
George A. Glover
James M. Perkins
Henry H. Marable
J. W. Bacon
S. S. May field
W. D. Dorris
Alexander Jackgon
R. C. K. Martin
John Shelby
S. G. Brigham
Thomas Norman
Thomas J. Walton
Henry Yandell
James Overton
John L. Hadley
T. C. Edwards
G. Troost
R. H. Gentry
Jonathan Bostick
John P. Williams
W. D. Jourdan
H. M. Parker
John B. Hubbard
M. H. Sneed
Thomas J. Martin
William Searcy
B. W. Avent
S. Bell
Walter H. Drane
A. H. Buchanan
James B. M. Reese
Jerman Baker
Andrew J. White
R. L. W. Hogg
Frank Davidson
Jonathan S. Hunt
Benjamin R. Owen
James H. Chairs
Thomas Barbour
Samuel Henderson
Joseph Mari
R. R. Hightower
Dennis John Doyle
Beverly 0. Watson
C. McAnally
Abraham H. King"
TRANSACTIONS OF THE TENNESSEE
William A. Ware
John B. Littlefield
A. H. Brown
J. W. Davis
George W. Warfield
II. Ridgely Dashiell
L. 1ST. M. Cook
T. S. Rives
R. Martin
S. H. Stout
N. Davenport
Jesse Isler
Dr. Iredale
J. D. Kelly
J. M. Anderson
R. Branson
J. M. Brewer
B. T. Bell
S. Condon
Alfred Cage
R. 0. Currey
Dr. Debow
J. Dudley
J. T. Dabney
S. Donelson
S. Edgar
James Fentress
J. Ferrill
A. Gillespie.
A. C. Goodlett
J. W. Hardwicke
J. T. Harrison
R. Holland
Wilson J. Hess
A. Hughes
Thomas Lipscomb
B. W. Lowe
Dr. Marlow
J. S. McNairy
P. W. Martin
Dr. Moore
Dr. Mallory
J. H. Marshall
G. M. McDaniel
W. B. Moores
Alexander McCall
Dr. Malone
Joseph Niblett
S. Nye
L. O'Brien
G. H. Parish
Dr. Pollock
J. W. Richardson
J. M. Rawles
Joseph Sandck
W. D. Scott
Alexander Stockard
A. H. Smiley
H. H. Thomas
N. Thomas
W. H. Trigg
John L. Taylor
James H. Yance
Joseph Wares
R. C. Webb
B. F. Weakley
Dr. White
Thomas C. Osborne
D. B. Cliflfe
George F. Jones
H. R. Robards
J. W. Stout
W. H. Wharton
A. W. Nelson
J. E. B. Robertson
R. S. Wendell
C. K. Winston
P. Smith
J. E. Manlove
Charles Smith
William A. Cheatham
John P. Ford
Dr. Callender
J. B. Lindsley
A. H. Baldridge
J. Walker Percy
R. M. Porter
F. H. Gordon
S. H. Woods
G. W. Burton
J. H. Lillard
J. J. Abernathy
John F. Waters
D. H. Johnson
Smith Bowlin
G. M. Alsup
G. L. Robinson
L. Y. Young
STATE MEDICAL SOCIETY.
John M. Watson
P. D. McCulloch
E. D. Wheeler
W. K. Bowling
D. W. Yandell
J. B. Armstrong
C. T. New
Samuel B. Bobison
R. W. Pain
L. W. Knight
E. B. Haskins
W. H. Morgan
M. Ransom
G. McDaniel
Robert C. Poster 4th
John D. Winston
John H. Morgan
John S. Duval
J. W. Gray
William H. McCombs
R. P. Evans
James C. Patterson
Thomas L. Maddin
Peyton S. Woodward
H. M. Whitaker
W. T. Briggs
P. G. McGavock
John W. King
William P. Jones