INDIANA MEDICAL HISTORY ", r QUARTERLY
THE FAMILY PHYSICIAN;
oa, Domestic Medical Friend:
CONTA.ININO PLAIN AND PRACTICAL INSTRUCTIONS
~OILTH!! PREVENTION AND CURE OF DISEASE:l,
WITH
A SERIES OF CHAPTERS ON COLLATERAL SUBJECTS;
C:O)IPJlllllfG ZV&aY THING llZLATIV& TO 'Ib• 'Ibtory a11d Principlu of tbt Mrdical Art,
)JEC&SSA.&Y TO B& X.lfOWN .y THE PRIVATE PRACTITIONER..
TJIE WHOLE ADAPT&Z. TO THI USE OP THOSE HEADS OF FAYILW WHO HAVE NOT HAD A CLASSICAL OR MEDICAL EDUCATION'.
BY ALEXANDER THOMSON, M. D.
AGTH()R OF A TREATISE ON NEI.VOUS DISORDERS; OFDlALOOU£5 IN A Ulk.Ut' AND OTHER PRODUCTIONS.
PnJNTED BY }AWES ORAM1 AT HIS PRINTtNC·OFFICE.J NO. 1()2, WATER•STRE£T.
1802,
INDIANA HISTORICAL SOCIETY
Volume V Number 1
March, 1979
R131 Al_IS_VS_NOl 001 IN THIS ISSUE
This issue of the Quarterly consists of a partial reprint of an early nineteenth century home remedy book. Printed in 1802 and tucked away with the precious few belongings of the westward migrating pioneer, this book was intended not only as a text for the private practitioner but also for "the use of those heads of families who have not had a classical or medical education." The title of the book is The Family Physician or Domestic Medical Friend, by Alexander Thomson, M.D. It was pub lished in New York City by James Oram. New York's population at this time was about 18,000. Some aspects of health have not changed a great deal since the book was printed, for example: "The cancer has hitherto baffled all the efforts of medicine ... . " In other areas however, the reader will not only be impressed with medical progress, he will also be impressed (and grateful) for progress in social customs and behavior; e.g. Dr. Thomson's comments on oral hygiene and care of the teeth: "We are doubtless far too inattentive with respect to the preservation of the teeth, considering of what importance they are in the chewing of food, which, without their previous exertion, would render it difficult for all the concoctive powers of the stomach to digest the aliment sufficiently. We do not often enough wash thera; we injure them, as has been already observed, by too free an [sic} use of sugar, or acids, which gradually corrodes their enamel; we wantonly contribute to destroy them by cracking nuts, or otherwise exposing them to violence; and instead of picking them with care, we employ a pick-tooth rather as a weapon of hostility than defence to the teeth .... (p. 214) " ... the care of (the teeth) ... is, in general, far from being sufficiently culti- vated. I believe that very few persons comparatively, wash their mouth in the morning; which ought always to be done. Indeed, though the operation seems not the most delicate to spectators at the table, this ought to be practiced at the con clusion of every meal where either animal food or vegetables are eaten: for the former is apt to leave behind it a rancid acrimony, and the latter an acidity, both of them hurtful to the teeth. Washing the mouth frequently with cold water is not only serviceable in keeping the teeth clean, but in strengthening the gums, the firm adhesion of which to the teeth is of great importance in preserving them sound and secure. "Picking teeth properly is also greatly conducive to their preservation; but the usual manner of doing this is by no means favourable to the purpose. A pick-tooth, with most people, is used in the manner of a tobacco-pipe ... "Many persons, while lauch•bly attentive to preserve their teeth, do them hurt by too much officiousness. They daily apply to them some dentifrice powder, which they rub so hard as not only to injure the enamel by excessive friction, but to hurt the gums even more by the abuse of the pick-tooth .... The quality of some of the dentifrice powders advertised in the news-papers is extremely suspicious; and there is reason to think they are not altogether free of a corrosive ingredient.... " (351-52) Dr. Thomson's comments on personal cleanliness remind us that although the wash basin was a common household item, the bath tub was not: "Personal clean liness is not only an amiable virtue but a source of comfort to the individual. For example after washing our feet we feel ourselves considerably refreshed; and this sensation would be still more perceptible, if the wholesome custom were intro duced of washing the whole body." The reader can form his own judgment in the following pages as to whether the average head of the family could benefit from the information they contain. The letter "s" adds to the interest of the book and is the reason for this form of repro duction.
R131 Al ---15 VS NOl 002 CHAP. XLIII.
Surgery.
IT would be inconfifl:ent with the plan of a work of this nature to defcribe the various operations of furgery. All that is required i~ to give a concife and clear account of the proper treatment of fuch cafes as may be managed without profeffional education for the purpofe, and which may occur where the affiftance of a furgeon cannot readily be obtained.
Bletding.
The mofl: common operation of furgery is that of bleeding; the knowledge of rightly performing which, is only to be acquired by example. Were we to judge of this operation by the frequency and facility with which it is praCl:ifed, we ihould be apt to con clude that it was a matter of very little importance; whereas, in fact, there is none that more affcCl:s the confl:itution, and even life itfelf, according as it is either negleCl:ed on one hand, or car ried to excefs on the other. This operation is proper at the beginning of all inflammatory fevers, fuch as pleurifies, peripnuemonies, &c. It is alfo proper in all topical inflamm:\tions of internal parts, fuch as thofe of the ftomach, inteftines, &c. and likewife in the apoplexy, afthma, rheumatifms, coughs, violent head-a.chs, and other diforders, pro ceeding either from too great a quantity of blood, or an impedi ment to its circulation. Bleeding is no lefs neceffary after falls~ blows, bruifes, or any violent hurt received, externally or inter nally; as it is likewife .in cafes of fuffocation from foul air, ftran gulation, &c. But in all diforders proceeding from a relaxed h.abit of body, and a vitiated fiate of the fluids, bleeding is inju.. no us. In t0pical inflammations bleeding ought to be performed ai near the part affeCl:ed as poffible; and, in general. the heft method of doing it is by a lancet: but where a vein cannvt be found, recourfe muft be had to the application of leeches, or cupping.
Leechu.
Previous to the :tpplication of leeches, the fk.in fhould be ca.re· fully cleanfed from any foulnefs, and moiftened 'Nith a little m1lk,
3
R131_A1_15_VS_N01_003 4 INDIANA MEDICAL HISTORY QUARTERLY
Cupping.
by which means they fafien more readily, and this farther promo. ted by allo~ing them to creep upon a dry cloth, or a dry board, for a few mmutes before application. The moft effectual method to make them fix upon a particular fpot, is to confine them to the part by means of a fmall wine glafs. As foon as the leeches have ~eparated, the ufual method of promoting the difcharge of blood ts, to cover the parts with fine linen cloths wet in warm water. But if the blood fhould continue to flow from the orifice made by a Ieee~, longer than is defired, as has happened, in fame inftances, to ch1ldren, who have been nearly loft by the inability of the attendants to ftop the difcharge; after carefully wafhing off the blood,. the point of the finger fhould be preffed moderately upon the onfice, and afterwards a comprefs be kept upon it for a little time.
Cupping.
When, either from the feverity of a local fixed pain, or from any other caufe, it is judged proper to evacuate blood directly from the fmall ve!fels of the part affected, infl:ead of opening any of the larger :;trteries or veins, it is ufual~ befides leeches, to employ fcarification and cupping. Slight fcarifications may be made with the fhoulder or edge of a lancet; or by means of an infl:rument termed afcarijicator; in which fixteen or twenty lancets are com monly placed, in fuch a manner that, when the inftruments is ap plied to the part affetl:ed, the whole number of lancets contained in it arc, by means of a firong fpring, pufhed fuddenly into it, to the depth at which the infl:rument has been previoufly regulated. This being done, as the fmaller blood-veffels only, by this opera tion, are intended to be cut, and as .thefe -do not commonly dif charge fr'-ely, fome mea· .., or other becomes neceffary for promo ting the evacuation. V ario•1s methods have been propofed for this purpofe; glafles fitted to the form of the affected parts, with a fmall hole in the bottom of each, were long fince contrived; and thefe being placed upon the fcarified pa'rts, a degree of futl:ion was produced by a perfon's mouth fufficient for nearly exhaufl:ing the air contained in the glafs. This method accordingly increafed the evacuation of blood to a certain extent; bt t as it was attended with a good deal of trouble, and did not always prove effectual, an exhaufting fyringe was at lafl: adapted tu the glafs, by means ~f which the contained air was extracted. The applicatwn of thts infl:rument however, for any length of time, is very troublefome; and it is difficult to preferve the fyringe always air-tight. The application of heat to the cupping-glafles has been foun~ to rarefy the air contained in them to a degree fufficient for producwg
R 131_A1_15 _VS _N 0 1_004 THE FAMILY PHYSICIAN 5
Cuppz'ng.
a ~ery conliderable fuction; and this expedientJ therefore, is now employed infiead of the fyringe. _ Difterent methods have been practifed for applying heat to the cavity of the glafs. By fupporting the mouth of it for a few feconds above the flame of a taper, the air may be fufficiently rarefied; bu't if the flame be not kept exactly in the middle, but allowed to touch either the fides or bottom of the glafs, the latter is very apt to be cracked. A more certain, as well as an eafier method of applying the heat is, to dip a piece of foft bibulous paper io fpirit of wine, and, having fet it on fire, to put it into the bottom of the glafs; and, on its being nearly extinguifhed, to apply the mouth of the infirument directly upon the fcarified part. This degree of heat, which may be always regulated by the fize of the piece of paper, and which, it is evident, ought to be ~lways in proportion to the fize of the glafs, if long enough applied, proves fufiicient for effeB:ually rarefying the air, and at the fame time, if done with any manner of caution, never injures the glafs in the leafi. The glafs having been thus applied, if the fcarifications have been properly made, they infl:antly begin to difcharge freely; and, fo foon as the infirument is nearly full of blood, it fhould be taken away. This may eaGly be done by raiGng one fide of it fo as to admit the external air. \Vhen more blood is deGred to be taken, the parts fhould be bathed with warm water; and, being made perfeB:ly dry, another glafs, exaB:ly the fize of the former, fhould be infiantly applied in the fame manner. Thus, almofl: any necef fary quantity of blood may be obtained. It fometimes happens, however, that the full quantity intended to be difcharged cannot be got at one place. In fuch a cafe, the fcarificator mufl: be again applied on a part as contiguous to the former as poffible; and, this being done, the application of the glaifes mufl: alfo be renewed as before. When it is wifhed to difcharge the quantity of blood as quickly as poffible, two or more glaifes may be ~pplied at once on conti guous parts previoufly fcarified; and, on fome occafions, the quan tity of blood is more quickly obtained by the cupping-glaffes being applied for a few feconds upon the parts to be afterwards fcarified. The fuB:ion produc..cd by the glaifes may poilibly have fome influ ence in bringing the more dcep-feated veifels into nearer contaCt with the fkin; fo that more of them will be cut by the fcarificator. A fufficient quantity of blood being procured, the wounds made by the different lancets fhould be all perfeB:l y cleared of blood; and a bit of foft linen, or ch:upie, dipped in a little milk or cre.am, :1pplied over the whole, is the only dreffing that is neceflary. vVhen dry linen is applied, it not only occafious n•orc uneafinefs ~a
R131_A1_15_V5_N01_005 6 INDIANA MEDICAL HISTORY QUARTERLY
ljfuu.
~he patient, but_render~ the ~:ounds more apt to fuff'cr than wheR 1t has been prevwufly wetted m the manner direCted . . D:-y-cupping confills in the ~pplication of the cupping-glaiTes dtrecl:ly to the parts affeCted, w1thout ufing the fcarificator. By this means. a tumor is produced upon the part; and where any advantage 1s to be expeCted from a determination of blood to a particular fpot, it may probably be more eafily accomplifhed by this means than by any other. When the part from which it is intended to produce a local evacuation of this kind is fo fituated, that a fcarificator and cup ping-glaffes can be applied, this method is greatly preferable to any other; but in inflammatory affetlions of the eye, nofe, and othe~ parts of the face, &c. the fcarificatur cannot be properly apphed to the parts affeCted. In fuch cafes, therefore, the com mon recourfe is to leeches, which can be placed upon almoft any fpot whence we would wiih to difcharge blood. Ij)im. Thefe are a kind of artificial ulcers, formed in different parts of the body, for the purpofe of procuring a difcharge of purulent matter, which is frequently of advantage in various diforderi. PraCtitioners were formerly of opinion that iffucs ferved as drains to carry off noxious humours from the blood; and therefore they placed them as near ihe affeCted part as pofftble. But as it is now known that they prove ufeful merely by the quantity of mat ter which they produce, they are generally placed where they 'vill occafion the leaft inconvenience. The moll proper parts for them are, the nape of the neck; the middle, outer, and fore part of the ihoulder; the hollow above the inner fide of the knee; or either fide of the b :-- ck-bone; or between two of the ribs; or where ever th~re is a fufficiency of cellular fubfi:ance for the protetlion of the parts beneath. '1~ hey ought never to be placed over the bel ly of a mufcle; nor over a tendon, or thinly covered bone; nor near any large blood-ve{fel. The iffues commonly ufed are, the blifi:er-iffue, the pea-iffue, and the feton or cord. \Vhen a bliller-iffue is to be ufed, after the blifi:er is removed, a difcharge of matter may be kept up by dreffing the part da.ily with an ointment mixed with the powder of cantharides, or Spamfh flies, or favin ointment. If the difcharge be too little, more of the po\'\•der may be ufed; if too great, or if the part be much inflamed, the iffue-ointment may be laid afide, and the yart dreffe(l with bafilicon, or with common cerate, till the dtfcharge be climinifhed, and the inflammation abated. . It is fometimei moft proper to ufe the iffue-ointment and a m1ld one alternately.
R131_A 1_15_V5_N01_006 THE FAMILY PHYSICIAN 7
L!Jlammation! and Ahjc1[e1.
A pea-i1Tue is formed either by making an incifion with a lancet er by cauftic, large enough to admit one or more peas; though fometimes, inftead of peas, kidney-beans, gentian-root, or orange peas are ufed. When the openin~ is made by an incifion, the fkin fhould be pinched up and cut through, of a fize fuffi.cient to receive the fubfi:ance to be put into it. But when it is to be done by caufi:ic, the common cauftic, or lapis infern:llis of the fhops, anfwers heft. It ought to be reduced to a pafi:e with a little water or foft foap, to prevent it from fpreading; and an adhefive plaf ter, with a fmall hole cut in the centre of it, fhould be previoufly p~'llced, and the caufi:ic pafi:e fpread upon the hole. Over the whole an adhelive plafi:er fhould be placed, to prevent any caufi:ic from efcaping. In ten or twelve hours the whole may be removed, and in three or four days th(! efchar will feparate, when the open ing may be filled with peas, or any of the other fubfi:ances above mentioned. The feton is ufed when a large quantity of matter is wanted, and efpecially from deep-feated parts. It is frequently ufed in the back of the neck for difeafes of the head or eyes, or between two of the ribs in affections of the breaft. When the cord, which ought to be made of threads of cotton or filk, is to be introduced, the parts at which it is to enter and pafs out fhould be previoufly marked with ink ; and a fmall part of the cord being befmeared with fome mild ointment, and paffed ·through the eye of the feton-needle, the part is to be fupported by an affifi:ant, and the needle paffed fairly through, leaving a few inches of the cord hanging out. The needle is then to be remov ed, and the part dreffed. By this method matter is produced in quantity proportioned to the degree of irritation applied; and this can be increafed or diminifhed by covering the cord daily, before it is drawn, with an irritating or mild ointment.
Inflammations and .tibfce.ffis.
All inflammations, from whatever caufes they proceed, canter· minate only in three ways, viz. by difperfion, fuppuration, organ grene. It is impoffible to foretel with certainty in which of thefe three ways any particuhr inflammation will terminate, yet a probable conjecture may b~ formed with regard to the event, from a knowledge of the patient's age and conftitution. Sligh_t infla~· mations from cold, and without any previous indifpofitwn, wJll mofr probably be difperfed; thofe which immediately fucceed a fever, or happen to perfons of a grofs habit of body, will generally fuppurate; and thofe which attack very old people, or perfons of a dropfical habit, will have a fi:rong tendency to a gangrene.
R131 -----Al 15 VS NOl 007 8 INDIANA MEDICAL HISTORY QUARTERLY
Injlammatiotu 4nd Abfa.ffu.
When the inflammation is flight, and the con!litutiort found the treatment fhould always be adapted to produce a difperfion: The heft means of promoting this end is the ufe of a flendcr dilu ting diet, fuflicient bleeding, and repeated purges. The inflamed part fhould be fomented with a decoB:ion of wormwood and cham. omile flowers; ;:mointingitafterwards with a mixture of three-fourths of fweet oil, ancl one-fourth of vinegar, and covering it with a piece of cerate, or wax-plafter. By means of thefe applications, in the courfe of three or four days, and fometimes in a fhorter fpace of time, the difperfion or reiolution of the tumor will in general begin to take place: at lean before the end of that period it may for the moft part, be known 1 how the inflammation will terminate. If the heat, pain, and other attending fymptoms abate, and efpecially if the tumor begin to ) dccreafe, without the occurrence of any gangrenous appearances, we may then be almoft certain that by a continuance of the fame plan a total refolution will in time be eifcB:ed. If, on the contrary, all the fymptoms rather increafe, efpecially if the tumor grow larger, and fomewhat foft, with an increafe of throbbing pain, we may then with tolerable certainty conclude that fuppuration will take place. The means which were ufed for difperfion mufl: now be laid afide, and endeavours be exerted to promote fuppuration. For this purpofe, flannels wrung out of any emGlient fomenta tion ought to be applied to the part as warm as the perfon can bear them, continued half an hour at a time, and repeated every three or four hours. Immediately after the fomentation is over, a large emolient poultice !hould likewife be applied warm, and renewed after every fomentation. Of ;· 11 the forms. recommended for emolient catap• lafms, 'l common milk and bread poultice, with a fmall portion of frefh butter or oil, is perhaps the mofl: eligible, as it not only } poffdfes all the advantages of the others, but can in general be more eafily obtained. Onions, either roafted or raw, garlic, and other acrid fubftances, are frequently m:~.de ufe of as additions to ripening cataplafms or poultices. When there is not a due d~gree of inflammati?n in the tumor, the addition of fuch fubftances n:ay be of fervtc<;; but when ftimulants are neceffary in fuch cafes, a fmall proportion of ftrained galbanum, or of any of the warm gums, diffolved in the yolk of an egg, and added to the poultices, is a more effeB:ual -pplication. . When the fwelling is come to maturity and matter 1s formed, which may be known by a re-miffion of all the fymptoms,. and generally likewife by a fiutluation, unlefs the abfcefs be tludly
R131 -----Al IS VS NOl 008 THE FAMILY PHYSICIAN 9
Wourulr.
cover~d with mufcles, it may be opened in the mofi prominent part either ·with a lancet, or by means of cauftic, or feton. The firft, however, feems preferable. In many cafes nature will do the work herfclf, and abfceffes, when fuperficially feated, will certainly burft of themfelves; but where the matter lies deep, we are by no means to wait for this fpontaneous opening; as before the purulent matter can break through the integuments, it m :::~ y acquire fuch an acrimony as will prove prejudicial to health. It is, however, a general rule not to open abfceffes till a thorough [epa ration has taken place: for when laid open before that period, and while any confiderable hardnefs remains, they commonly prove more troublcfome, and fcldom he:1l fo kindly. The lafr way in which an inflammation terminates, is in a gan grene or mortification, which makes known its approach by the following fymptoms. The inflammation, from b~ing r~d, afii.unes a dufkifu or livid colour; the tenGon of the fkin goes off, and it feels flabby; little bladders filled with a thin acrid Huid of differ ent colours fpread all over it ; the tumor fubfides, and at length becomes black. The pulfe at this period is quick and low, cold clammy fweats break forth, and death in a fuort time enfues. On the firft appearance of thefe fymptoms, the part ought to be embrocated with a folution offal ammoniac in vinegar and water: a drachm of the falt to two ounces of vinegar anJ. fix of water, forms a mixture of a proper frrength for every purpofe of this kind; but the degree of frimulus can be eafily either increafed or diminifued, according to circurnftances, by uGng a larger or fmaller proportion of the falt. In this cafe the patient muft be fupported with generous wines, and the Peruvian bark adminiftered in as large dofes as the ftomach will bear. If the mortified parts fhould feparate, th<= wound will become a common ulcer, and muft be treated accordingly.
1Vormd.r.
It is a prevailing, though erroneous optmon, that particular smd fpecific applications are neceffary for the cure of wounds ; while, in fact, neither herbs, ointments, nor plaftcrs, contribute to this purpofe in any other way than by keeping the parts foft and clean, and defending them from the influence of the external air. Dry lint alone, therefore may be as ufefully employed for produc ing the defired effect as :my of the moft extolled applications in the' province of furgery. Medicines taken internally are no lefs inadequate to accompli1h the cure of wounds than thofe externally applied. It is nature alone thfl.t conduch the cur;~th·e procefi in eyery diYifion or lofs of
R131 -Al ----15 VS NOl 009 10 INDIANA MEDICAL HISTORY QUARTERLY
1Vomrdi.
fub~a:1ce incidental to the folid parts of the human body; lnd m~dicmes can on~y promote that objeCl by removing whatever might obfrrua or Impede her falutary operations. ~hen a ~erf~n has re~eived a wound, the firfr thing which clatms attentiOn IS to examme whether any foreign fubfl:ance, fuch :as lead, iron, glafs, bits of cloth, or the like, be lodged in it. Thefe, if poffible, ought to be extracted, and the wound cleaned before any dreffings be applied. But when the patient's weaknefs or lofs of blood will not admit of th,e extraCtion immediately, the fubfbnces muil: be fuffered to remain in the wound till he can bear their removal with more fafety. In wounds which feem to threaten the lofs of life, the affiftance of a furgeon is indifpenfable; but fometimes the difcharge of blood is fo great, that, if fomething be not done immediately to ftop it, the perfon may expire before fuch affiftance can be procured. It is therefore of importance to know what ought to be done in an emergency of this kind. If the wound be in any of the limbs, the application of a tight ligature or bandage round the member a little above the wound may generally flop the bleeding. To ac complifh this objeCt:, the heft expedient is to put a fl:rong broad garter round the part, but fo flack as eafily to admit a fmall piece of frick to be put under it ; which muft be twifred, in the fame manner as is praCl:ifed by countrymen to fecure their loading with a cart-rope, till the bleeding ftops. But when thi~t is effeCted, the garter muft be twifl:ed no longer, as ftraining it too much might produce an inflammation of the parts, and endanger a gangrene. In parts where fuch a bandage cannot be applied, rec;ourfe muft be had to other methods of flopping the hxmorrhage. Cloths dipped in fryptic water, or in a folution of blue vitriol, may be applied to the wound. When thefe cannot be obtained, fl:rong fpirits of wine may be ufet. for the purpofe. The application of even common writing-ink might be of advantage. The agaric of the oak has been defervedly recommended for this purpofe. The part to be ufed is that which lies immediately under the outer rind; and the only preparation it requires, is to be beat well with a hammer till it becomes foft and very pliable. A flice of it, of a proper fize is to be applied direCtly over the bleeding veffels. Where the aga ric cannot be had, fponge may be ufcd in its fread. Whether the :agaric or fponge be employed, it ought to be cov~red wi.th a good deal of lint, above which a bandage may be apphed fo tight as to keep it firm upon the part. In flight wounds, which do not penctnte much deeper than the fkin, nothing better can be applied than the common blac.k fti~king-plafter. lly keeping the fides of the wo·und together, thJJ
R131 -Al ----15 VS NOl 010 THE FAMILY PHYSICIAN 11
WounJr •.
prevents the admiffion of air, which' is ali that is required for pro moting the: cure.. Eut when a ~ound penet~ates deep, its lips muft not be kept too clofe, as thts would retam the matter, and might occafion a fdl:ering of the. part,. In fuel:!. a caf~, the beft m~thOd is to fill the wound. with charpi~ or caddis, which, ·ho:'!v -ever, ought not tq be ftnffed in too hard. This application may be covered with :i cloth dipped irt oil, or fpread with the common wax:-plafter; and the who!~ mufi he retained by a proper' bandage. The firft dreffing· fhould be allowed to remain for at le~:fi two days; after which it may be removed, an4·frefh caddis or charpie be applied as before. If any part of the firft dreffing adher.es fo dofe as not to be · removed without occafioning pairi and violence to the wound, it may 'be allowed· to: (;Orttinue, _and fame .frefQ materials of the fame kin.d, dipped in fweet oil, be laid over it. It wiH by this means 'be fo m\lch foftened,.· as to come ofF ealil)• a~ the next dreffing·. The wound· may afterwards be drdfec twice a day in the fame manner'till it be qu-ite healed. Thofe who c.on ~der·this method as too fimple, m~y,, after the wound is become very fuperficial, dr~fs it with t~e ointrt1ent callei.l yellow oafilicum. and if any fungt;ous or proud flefh, as it is termed, !hould rife i.n the wound~ it m
R131 --A1 15 ---VS N01 011 12 INDIANA MEDICAL HISTORY QUARTERLY
Bur:llt.·:a.nd S&a!Jr.
· V~r1ou$ remedie:J are tec.ummended for-the tteatment of thtfc accident~~ and. it ha:pPfns· fortuMtdy far· the. pre(lure of fuch,an ~erg·ency~ that f.ome of tf,.e mo~ common things are alfo the moft .u(e!~l on the occafi'on. The 'tl'llll of ·burns and fcalds may be i~P ~~~~Y · .abated by im'!lerfin~ th~ Jlart a~eC..led in cold water, ~ J~oee<:i. m a~y cold flutd, or m .fpmts of wme. An excellent applr ~at~(>n likewi.fe is vinega"t, with or wjthout powdered chalk in it. lf the injury be on the fingers or hands, the application may be . maM _by i~me:d'ion; but if. ~ll any paxt. where t.Pis would be incbruo 'venie:in, the- v'inegar.may be ~m>Iied· by!me~n~ Qf linen rags dipped ~n. it. · ~ flighJ mjp:ries,. ~he v.inegar, if .early ann _affidioufiy ap ph.ed, w11l oj 1tf~It (oo.n effe<-\ ~ c~re ~ : ~~t' !Jlould any degree of ~~n return, the ·~edron _i>.r .t9m~ntat\?XI · mut'l be. repeated. . · .In recent h.urns or {'Cald~, , ~~t~nded WI~ · large bhfi:ers, exc~ria ·ttoris, or lots of fubftari~, tlie :yinegar,o.ught to be appl_ied till the ·_pai~ neady .ceaf~s~ which ~enerally happens within eight ho~t:.. ~any pr~titioners r~.c.9mimnd fpirits of turpe~tine inftead of.vi{l, ~g~r; pr li;me--~ter ;md~ IJ.nfeed-oil. 'l'he v.ht~g.ar need not he :e.mployed• . long~r. th~- twelv7,-hour,s, ex~<:pt qn , ~e oullflde qf ~~ . fore~, wh1ch, w1ule tber cbntmue to be fwelled :ot.mflamt;d, ~ouW be. fqmepte~: for a rui~u~e 'i)f iwo 9efore.. they are dreife4·· . · For. dretfing ~he {ore$_. wpich ~rife from . burn~ or fcaids, one ..of the ben ·a ·pplications is ~ povlti~e c;>f bre~d, wa.t~r, · ~nd (we(:t. o4< This fhould be , remov~d in fix ho.urs,. when the fores are to be covered' with cpalk'fi'nely powdered, tilfit has. abforbep the mat ter, a~d appears quite 'dry • . A frdh . PC?Ultice mu.fl: be laid . o.ver ~e w~ole, whi~h, :With ,th~ fp:rin.kliog _ ~f the chalk, i$ to be repeated .rnotn1ng .. and evem~g folU . th~ : for~tJ are h~led. . . Aftet th -:· fecond· or ~li,.;f day, if tile fares ~e on a part of the body where it is ~iffi·~ult .to_keep the r,uul~ice from thif~~g, a p~~ ·ret o~ · cerate, th1.ckly fprea?,., . may be ~1ed , a~ a .fubfi:ttute m t.hc ·4ay-t1me.. . . _ · When. there are large blifters 'upon the part they ihould b~ opened with a lancet before the application of the vinegar; ~tnd the water they contain be preffed out with a linen doth? t~t t~e vinegar ·may act more ~lofely upon the burnt lldh, whteh m th11 cafi; it does efficacioufly. In· fevere cafes, and in cold weather, the :vinegar fhould be nearly blood-warm. . . . . If the patient willl}ot fuffer the vinegar to be -apphed ~mmedl: atdy to the furface; on account of the pain it excites, ·a lmen ~ag foaked in fweet oil may be previoufly laid on the part, c?ve~mg the whole with cloths dipped in vinegar; and thefe apph~atwn~ are to be ~ccafionally repeated til~ the pain and inflammat1on be.
R131_A 1_15_VS_N01_012 THE FAMILY PHYSICIAN 13
entirely removed; after which. . the~~ parts lhould be dreired or if ~he burning be very deep, with a mixture of that and yello,~ bafil. ICOn. When the burn or .fcald is violent, or has produced a high degree of inflammation, fo that there. -is reafon to be apprehenfive of a gangrene, the· fame ·method of cure becomes nece.if:ary as itt other violent inflammations. The patient, in this cafe, muft be put upon ~ lo~ diet, and drink p~entifully of weak diluting li'!uor~ He muft hkew1fe be bled~ - ~nd h1s body be "kept open. But · ~f thd burnt parts fhould become livid or black, with other fymptoms· ol .mortification, it will be neceffary, to apply to them camphorated fpirits Qf wine, tiritl:ure of myrrh, and other antifeptics· or corrector$ pf putrefaCl:ion, mixed with a decotl:ion of the Peruvian :bark. Irt this cafe, the bark.ri1uft likewife be taken"internally; the patient at the fame time ufing a· more generous diet,.with wine, fpicerie~, &c~ When burns are. ..occafioned by. the ..explofion of guh powder, fome of the grains of the powder are apt to. be forced .into the fkin. At. firft they produce: much irritation; and; if they be not rem~wed, they commonly leave marks which remain during life.· . They fhould therefore be picked out as .foon as poffible after the acci.. dent; and to prevent inflammation, as well as to diffolve any pow... der which may .remain, the parts affeCl:ed, fuould be covered" for a day or two with emollient poultice$, A {l:rong folution ot ..f~.ap in water has long been, in ufe with artificers employed. in any bufinefs· expo£ng workmen to v.ery bad fcalds. This is allowed to be an.ex.cellent remedy. But,. as the foap would take fame time in diffolving, .arid the folution fome time in cooling, Dr. U hderwood recommends a mixture of fix ounces of oil to ten of water, with two drachms of the ley of kali, or pot• ~{h. This quantity may be fufficient for a burn on the · hand or foot, which· is to be immerfe~, and kept about half an ·hour in the liquor, which will remove the injury, .if recourfe to ~t in:mediately be had; but muft be· repeated, as the pain may requ1re, 1f the fcald or burn b'e 9£ fome fianding. The moft ufeful application, we are told> with which families can be provided againft_any emergency of this kind, is a ftrong brine, made by placing fliced potatoes and common Jalt in alternate layers in a pan, allowing them to remain until the whole .of the falt is liquified; which muft be then drained off, ~tnd kept m bottles, properly labelled, ready for immedi~t~ ufe.
R131 -----Al 15 VS NOl 013 14 INDIANA MEDICAL HISTORY QUARTERLY
Brriife.i.
As bruifes exift. in various degrees, they are to be treated accord. ingly. .ln. flight caf¢.5 it will be fufiicient to foment tho part with w.arm tfi~ar) to whtch may ·be add~d acc~fionally a little brandy 9.~ vum, ana to keep canftantly apphed to lt cloths wet with this ~xtur~~ But when :.l brui~e i.s very violent, the patient ought pnmedtately to be bled. Hts dtet fhould be light and cool, con uftillg chiefly.of. vegetables; and his dri\lk weak, and of anopen V\g 1ltlt}{re, _ f~ch as whey fweetened with honey, cream of tarta1' wb~y, :deco~hons of t~~arinds, &c. The hruifed part muft be foPl~t~ · Wlth. warm vmegar and water ; apply:ng to it, after~ W!lrds, ·a ~poulttee maae by boiling crumb of bread,· elder .flowers, artd diamomile-fiowers, in equal quantiti~:s of vinegar and water. Thi~ poultice may be reneWed two or three ~imes a day, and is particularly proper when the bruife is attended wi~ a wound. When a-bruife is attended. with a violent pain, twenry.. five or ~irty -drops of laudanum may be given, and repeated in a few hourj, if l1ec~ary. Ulcers.
An ulcer is a folutio{l of the continuity in any of the fofter parts of the body, difcharging pus, fanies, or any other matter. The¥ may .lnpperi in confeqtience of wounds,. bruifes, or 1mpofthumes impropaly treated; and may·likewife proceed from a bad habit of body• in which the humours are depraved, by poor living, or a r.rilt of.fuffident exeroife. When an ulcer difcha'rges matter of a mild kind, and a good conftftencet called laudabl¢ pus, it is in a fair way of healing in a ihort time; but if it be·of ·long duration, the humour watery and acrid, -anc\ the edges c::llous· or hard; the cure of it is generally ntremely difficult and teoivus: In faa, as ulcers of this. defc!il!~ tJtm proceed from a bad hab1t of body, or veneTeal tamt, 1t 1s more fafe to refrain from attempting to heal them, until the con• ftitution be improved by a proper regimen, or medicines; and when fuch .a change ha& taken place, they will be difpofed to heal of their own ~ceo rd. Ulcers which have been occafioned by malignant fevers, or ¢her acute difeafes, may for the moft part bt fafely healed after the patient's health is entirely re-eftab1ifh e~ ; though even then he rnuft obferve a proper regimen, and his body be kept open ~y gentle purgatives. The fame caution muft likewife be ufed,_ m refpeCl to ulcers which accompany chronical dife a fe ~. It may be laid down as a general rule, that if during the ~ontmuance of an ulcer the perfon otherwife enjoys good health, 1t ought not to be
R131_A1_15_V5_N01_014 THE FAMILY PHYSICIAN 15
healed, efpecially If it be of : long ftanding; but if, on the ron· trary, the patient's firength fenfibly declines, the cute of it (hould be promoted with all PQfiible fpeed. . . A ftrilt attention to regimen is m no cafe more neceffary thatt in the cure of ulcers~ To promote it, the patient muft b~ tempt~ nte in eating and drinking; muft live chiefly on cooling laxat'ive vegetables, avoid all high feafoned food, and ftrong liqu0rs; and for dr.ink ufe butter-milk, or whey f~eetened with honey. He ought alfo to take mederate exercife, and cultivate a cheerful dif• pofition. When the edges or any part of an ulceT are hard and callou1, they may be fprinkled twice a day with a little red precipitate, and afterwards dretfed with the yellow bajilicum ointment. This i~ tikewife done by touching them a few days with the l~nar cauftic~ Some praltitioners cut them off with a knife; but this is a pain• ful operation, and not more efficacious. Lime-water is often of ~reat efficacy iP. the cure of obft~n .ate ulcers : for which purpofe tt may be ufed in the fame manner as dire6l:ed with regard to the ftone and gnvel ; and in all cafes of obftinate ulcers, the Peruvian bark, plentifully adminiftered, will be found of great advantage. When ulcers are attended with great pain and infiamm~ti~, bleeding, ami opening the body with pJlrgatives, will often be fer vi£eable ; but, above all things, reft, and a horizontal pofture ; which laft circumftance is of fo great impo.rtance to the cure of ulcers in the legs, that, ~nlefs the patient ftricUy conforrfl. to it, the, fkill of the furg€on, h~wever well direlted, will often prove abortive :. for, ·as the indifpofition of thefe fores is in fome me~fure owing to the gravitation Of the humo~rs downwards, it will be . much more beneficial to ·tie along than fit »pright, though the leg be laid on a chair; fince even in this pofi:ure they will def~en4 with more force than if the body was reclined.
R131 -Al -15 -V5- NOl -015 The Indiana Medical History Quarterly is published by the Medical History Section of the Indiana Historical Society, 315 West Ohio Street, Indiana polis, Indiana 46202.
R131_A1_15_VS_N01 016 INDIANA MEDICAL HISTORY
QUARTERLY ~ ~ - -
INDIANA HISTORICAL SOCIETY
Volume V Number 2
June, 1979
R131_A 1_15_VS_N02_001 The Indiana Medical History Quarterly is published by the Medical History Section of the Indiana Historical Society, 315 West Ohio Street, Indiana polis, Indiana 46202.
MEDICAL HISTORY SECTION COMMITTEE
CHARLES A. BONSETT, M.D. Chairman and Editor 6133 East 54th Place Indianapolis, Indiana 46226
JOHN U. KEATING, M.D. 8415 Washington Blvd. Indianapolis, Indiana 46240
KENNETH G. KOHLSTAEDT, M.D. 645 East 80th Street Indianapolis, Indiana 46240
BERNARD ROSENAK, M.D. 5 254 North Delaware Street Indianapolis, Indiana 46220
DWIGHT SCHUSTER, M.D. 4503 Washington Blvd. Indianapolis, Indiana 46205
WILLIAM M. SHOL TY, M.D. 1831 Lilly Road Lafayette, Indiana 47905
W. D. SNIVELY, JR., M.D. R.R. I, Box 277 Evansville, Indiana 47712
MRS. DONALD J. WHITE 3524 North Meridian Street Indianapolis, Indiana 46208
The Committee invites the contribution of manuscript material relating to the practice of medicine in Indiana - letters from or to physicians, diaries, case books, etc. Identified pictures of 19th century Hoosier doctors or medical meetings are also being sought. Objects relating to medical practice are desired for the Museum. Please write to Dr. Charles A. Bonsett, Chairman, Medical History Section, Indiana Historical Society, 140 North Senate Avenue, Indianapolis 46204.
Cover: Dr. Corydon Richmond (1808-1906), graduated from the Ohio Medical School in 1832 and then came to Indianapolis. In 1844 he moved to the Indian Reserve in Howard County and helped settle the town of Kokomo.
R131 -Al ----IS VS N02 002 IN THIS ISSUE
The Journal of the Indiana State Medical Association originated in 1908. From 1849 until 1908, it was titled The Transactions of the Indiana State Medical Society. Relatively few sets of these volumes are to be found at the present time. As a source of medical information, of course, they have long since lost their value, but as a means of gaining insight into the methods, thoughts, and concepts of 19th century Hoosier physicians, these transactions are invaluable. The present issue of the Quarterly reproduces three articles from two volumes of these transactions. The first article, from the 1879 issue, is by Dr. Corydon Richmond, and the remaining two articles, from the 1885 issue, are by Dr. Joseph Eastman and Dr. William Lomax. Dr. Corydon Richmond writes about the early settlement of Kokomo, and the diseases encountered there at that time. Dr. Corydon Richmond was the son of Dr. John Richmond, who performed what is believed to be the first recorded Caesarean section in America, April 23, 1827. Corydon Richmond lived from 1808 to 1906. He was graduated from the Ohio Medical College in 1832 and settled in Pendleton, where he practiced until 1838. He then moved to Indianapolis. In 1844 Dr. Richmond moved to Howard County, built a cabin, and along with others began the city of Kokomo. In 184 7 he was a member of the State Legislature. During the Civil War he served as an assistant surgeon and in 1867 he was elected Mayor of Kokomo. Dr. Richmond was 71 years old when he wrote the recollections which are repro duced in this issue of the Quarterly. The Volume 1, number 2 issue of the Medical History Quarterly featured Dr. Joseph Eastman on the cover and presented a biographical sketch. Dr. Eastman, who was a Hoosier surgeon of national repute at the turn of the century, was a founder of the Central College of Physicians and Surgeons of Indianapolis. He had his own hospital and was the innovator of several surgical procedures which gained him an international reputation. In 1885 Dr. Joseph Eastman presented his paper entitled "Abdominal Surgery with Cases and Comments" at the 35th annual session of the Indiana Medical Society. The paper gives the reader a very good concept of Dr. Eastman's ability both as a diagnostician and as a teacher. Dr. William Lomax was born in Guilford County, North Carolina, March 15, 1813, and died at Marion, Indiana, where he had spent most of his professional life, on April 27, 1893. He attended the Medical College of Ohio at Cincinnati in 1836, and later, in 184 7 and 1848, attended the series of lectures at La Porte Medical College, where he received the M. D. degree. He was graduated in 1850 from the University of the City of New York. He practiced at Marion until the outbreak of the Civil War. He served as Medical Director of the Fifteenth Army Corps. He returned, following the War, to Marion, where he continued to practice. He was one of the founders of the Grant County Medical Society in 1848, and of the Indiana State Medical Society in 1849, serving as president in 1856. Dr. Lomax was an early and enthusiastic advocate of continuing medical education, and he was continuously involved in upgrading medical education for the medical student. His generosity provided the money which built the structure in Indianapolis that would become the Indiana University School of Medicine from 1908 to 1919. This building, now razed, was known throughout most of its existence as the State House Annex. Dr. Lomax was a frequent contributor to the Transactions. His views on the subject of the abusive use of alcohol is of interest. The reader may or may not agree with Dr. Lomax in his opinions.
3
R131 Al ----15 V5 N02 003 INDIANA MEDICAL HISTORY QUARTERLY
ABDOMINAL SURGERY WITH CASES AND COMMENTS.*
BY JOSEPH EASTMAN, M.D., Professor of Gynecology and Clinical Surgery in Central College of Physicians and Surgeons, Indianapolis.
CASE I.
Miss X, aged 24, single, raised at housework on a farm; had followed same occupation in this city for the past two years. I was called to see her first October 12, 1884; found her suffering intense pain, located in the occipital region, extending down the back of the neck. Her head was drawn backward, the muscles of the neck were tense and unyielding; she was scarcely conscious, and could talk but little; enough, however, with what I gathered from her sister, to enable me to determine that there had been a sharp, lancinating pain in the right iliac fossa, preceding the pain in the back of the head. Examination in this region disclosed a tumor resembling a large bubo in shape and location. Her suffering seeming to be intensified by my examination, I gave her a hypodermic of % gr. of morphia. Her tongue was dry and protruded with difficulty; pulse, 125; temperature, 103. I learned from her sister that she had been treated for typhoid fever for two weeks. I prescribed a mixture containing xv. grs. bromide potassae and 1/8 gr. morphia in each teaspoonful, to be given every hour; also directed hot applications (sponges taken out of hot water) to be bound over the tumor, and hot vaginal irrigation every hour. I saw her next morning; she had rested some better than formerly during the night, yet the usual effect of bromide to relieve pain in the cerebellum was not well marked. This fact suggested additional proof to my mind that the pain in the head was excentric. At this visit she was able to assist me in tracing back the history of her case to a time two weeks prior, when lifting a washtub half full of water, "she felt some thing give away in her right groin." A more thorough examination, both vaginal, rectal and abdominal, convinced me that I had to deal with
A HERNIA OF THE OVARY.
Medicinal treatment during the next few days failing to give more than tempo rary relief, I took Dr. J. A. Sutcliffe with me at my evening visit. The doctor verified my diagnosis and my opinion that an operation was the only source of relief. We secured a coal oil lamp, asked the father to hold the same, and proceeded to operate. I cut down to the ovary, and found it and the fallopian tube surrounded by at least a tablespoonful of pus. These wandering organs occupied the inguinal canal, which I opened freely, applying a ligature around the tube and ovarian liga ment as closely as possible to the internal abdominal ring, removed the ovary and tube, closed the upper angle of the wound, allowing the lower angle to remain open for the escape of the ligature and drainage. Patient made a good recovery.
REMARKS.
Ovarian hernia is of rare occurrence. I believe, however, that in the advance of abdominal surgery it will be found that ovaries prolape in different directions; and where, as in some cases the ovaries can not be found by abdominal section, a search in the inguinal canal will detect an ovary on its way to the labia majora, imitating its analogy to the testicle in its descent toward the scrotum.
4
R131 A1_15_V5_N02_004 ABDOMINAL SURGERY
CASE II.
Miss Y., aged 26, consulted me in September, 1883, for painful menstruation, which had gradually become worse since a period about seven years before, when she received a jolt in alighting from a buggy. She had suffered many things from many doctors, and had rather gotten worse. She had been treated for "womb disease" with caustics, washes, pessaries, etc. She was emaciated and bloodless, the ovaries and tubes enlarged and tender, and the left ovary felt in Douglass' pouch per vagina. I required her to go to St. Vincent's Hospital, directed hot vaginal douche twice a day, to be used with an irrigator which distends the upper part of the vagina, so as to bring a great quantity of hot water against the pelvic roof. I also directed as much hot milk as the stomach would bear. Under this treatment, carried out some two months, she felt much better, though she still suffered intensely at her menstrual periods. She returned home, a distance of some fifty miles, with the understanding that if her health did not im prove, she would return and submit to the removal of ovaries and tubes. She returned October 24, 1884, her last menstruation having been so intensely painful as to make her desperate in her demands for relief. I opened the abdomen October 26. The ovaries were a third larger than normal and somewhat engorged. The left was prolapsed into Douglass' cui de sac and adherent; the fallopian tubes were the seat of chronic inflammation, the left one oc cluded at its uterine extremity, and had two cysts containing water attached. The right tube was less diseased, but had one cyst containing a watery fluid. Highest temperature reached, 102; pulse, 120. Her recovery has been retarded; there remains some of the pain running downward from the seat of the adherent left ovary; she has also suffered from hot flashes and burning sensations. I think her ultimate recovery is assured.
REMARKS.
These hot flashes at the menopause, whether the same be natural or produced by extirpation of the ovaries, are due, in my judgment, to absorption from the uterine cavity of septic material, resulting from retarded cicatrization taking the place of the more rapid and perfect repair of healthy menstruation. We may have, as another cause, absorption from the seat of constriction of the pedicle by the ligature, as there is nearly always a slight localized inflammation at this point. This case is not reported to show that removal of the uterine appendages is a remedy for dysmenorrhoea, except in such cases as a most careful and thorough examination by all methods reveals decided organic changes in the ovaries or tubes, or both combined; and not even then until the bromides and ergot, with hot milk in large quantities by the stomach, hot water in great quantities by vagina, and a thorough trial of the galvanic current passed through the diseased organs, has failed to cure. There are many such cases of hysteric, cataleptic, epileptic, morphine poisoned, nerve-wrecked, brain-shattered, reason-dethroned, asylum-homed women, whose lives are, in their own words, "scarcely worth the living," despite the remedies I have mentioned. Some of them are being made worse by treatment for uterine disease by doctors whose only means of diagnosis is the speculum and sound. These women are essentially sterile; these organs are decaying foreign bodies, and their re moval justified by sound surgical principles.
5
R131 Al ----15 V5 N02 005 INDIANA MEDICAL HISTORY QUARTERLY
CASE Ill.
Miss Z, aged 22, had been a sufferer from menorrhagia and metorrhagia for eight years; for the past four years uterine hemorrhage was constant, except when temporarily controlled by treatment. Prof. Parvin had on several occasions used the curette, and applied Churchill's tincture of iodine; at other times dilated with tents and used the stronger acids. I examined her in March, 1884, dilated the uterus with sea-tangle tents, and scraped from the interior of the uterus a teasponful of granular substance-a sort of fungoid growth. The hemorrhage was quite free. Wiping out the uterus I applied fuming nitric acid, after the plan of Athill. I waited ten days, dilated again and applied acid. She then returned home, a distance of eighty miles, remained entirely free from any flow whatever for seven months, and seemed to be well when a fairly normal flow appeared. In twenty-eight days from cessation of the flow an alarming hemorrhage took place. She wrote me: "If you will do the operation you spoke of, I will return to your care for the same, but will not submit to any other treatment." November 4, 1884, I opened the abdomen and found the left ovary a mere sack, containing a fluid about the color of coffee. It had undergone cystic degen eration. The right ovary contained one large cyst which occupied one-third of the capsule; the tubes were healthy, except that the left was adherent by its fimbriated extremity to the ovary. At the beginning of the operation a sound was introduced into the uterine cavity, for the purpose of lifting the uterus upwards to the ab dominal incision. The introduction of this sound was followed by a free flow of blood, which continued during the operation, amounting to several ounces. After the withdrawal of the sound the hemorrhage stopped, and two weeks later, when she was ready to return home, the introduction of the sound was not followed by a drop of blood, and the fungoid growths, which were very red when removed by the curette on former occasions, were now dark brown and bloodless. Highest tempera ture, 101; pulse, 120. At the end of two months from the date of the operation she wrote me she was well and has remained so ever since.
REMARKS.
In this case, I am inclined to the belief that the adhesion of the fimbriated extremity of the tube to the ovary was the main factor in maintaining the disturbed relation between the tube and uterine cavity; the periodic movement and attach ment of the tube to the ovary being an essential condition to the tubal engorgement found at the menstrual period. "Permanent adhesion of the tubes to the ovaries, the result of perioopheritis, is often met with in women who have led lives of prostitutes; and in them a sort of permanent metorrhagia is by no means rare." The relation of cystic degeneration of the ovaries to fungoid degeneration of the lining membrane of the uterus, and consequent hemorrhage has not until recently been recognized.
GENERAL CONSIDERATIONS.
In order to avail ourselves of modern advancements in gynaecic surgery we must, especially for diagnostic purposes, understand and appreciate the advances made in physiology; for, within the last few years, the physiology of menstruation has been turned "upside down," so that it is an accepted fact that ovulation begins even in intra-uterine life, and may continue to old age; while the fallopian tubes and uterus (both being developed from the same structures- the tubes of Muller) are the
6
R131 -Al ----IS VS N02 006 ABDOMINAL SURGERY
organs in which the change occurs at puberty and at the menopause. Mr. Tait says he has "been unable to find in the tubes of a girl under the age of puberty any of the ciliated epithelium which afterwards lines it." His opinion is, therefore, "that the changes in the ovary at puberty are entirely vascular; that in the tube they are vascular, muscular, and epithelial. But the most important change of all is the functional movements of the tubes, the absence of which alone makes pregnancy before puberty impossible. At the menopause the changes which are most apparent are those effected in the uterus and tubes; these structures rapidly diminish in size, the tubes are straightened and cease their movements. Here we have proof that ovulation and menstruation are wholly independent; that menstruation is not dependent on the ovaries or ovulation." Mr. Tait also furnishes "reports of forty-nine cases where actual observation in nine of which ovulation and menstruation were concurrent; fifteen cases of negative proof against the ovulation theory of menstruation, and twenty-five cases affording positive evidence against the theory." Other authorities could be cited, but it is unnecessary, for with the more frequent abdominal sections, we shall find facts driving theories from the physi ological field, and that incurable dysmenorrhoea will have for its cause diseased fallopian tubes, and that if the fimbriated extremity becomes adherent to the ovary by inflammation we have an almost constant uterine hemorrhage. The remedy, in either instance, is the removal of the uterine appendages and arrest of that periodical discharge of blood which belongs almost entirely to woman, and which, knowing how the sight of blood subdues man's passions, was possibly a wise provision of Deity to secure, short though it be, a period of rest for woman's genital organs. As to the dangers of the operation, it will depend on who does the operation, when and where he performs it. The more times one operates (other things being equal), the more successful he will be. Second. In this operation, as in all others of any magnitude, to obtain success, it must be performed before the forces of death plus the operation are stronger than those of life. And let me admonish those advising in these cases, that operations left as forlorn hopes will often give results partaking more of the forlorn than the hope. If the entire stock of stamina has been used up by weeks, months, and years of torture and pain, the dangers in operating are increased. Third. This operation ought not (where it can possibly be avoided) to be done at the patient's home. The hospital where she can be entirely under control of the surgeon is the only suitable place. With the success of European and some of our American operators, we ought to rescue many of these women from lives of suffering and misery.
DISCUSSION.
Dr. Hibbard-Mr. President, I would express the interest I feel in the physi ological part of the doctor's excellent paper. I acknowledge the statement he has made here is entirely new to me. I am not sure that I understand it entirely, but if I do, it is that the ova in the human family is gotten up at the same time that the ovary itself is developed, and it is there retained, ready for operation whenever the sudden change takes place in that appendage of the uterus, and it continues so until extreme old age. Is that so? Dr. Eastman- Yes, sir.
*Author's Note: This paper is a report of some work to the Marion County Medical Society, which was deemed worthy of reference to the State Society. It is in no sense an exhaustive paper.
7
R131 A1_15_V5_N02_007 INDIANA MEDICAL HISTORY QUARTERLY
CHRONIC ALCOHOLISM.
BY WM. LOMAX, M.D., MARION, IND.
Alcoholic inebriety has a definite natural history. Its distinctive features are so well marked as to leave no doubt or difference of opinion in the minds of those who observe them. And the evil is so widespread in the civilized world as to permit no } one to be ignorant of its prevalence and destructive power. If let loose to prey at will upon the unprotected interests of society, it would prove a more unsparing ) destroyer than any other scourge in the long catalogue of human plagues. There is no desolating evil which an intelligent and well-informed community would more sincerely deprecate; and none which a far-seeing jurisprudence would more anxiously provide against and avert. In every age of the world it has been recognized as a blighting scourge. Philanthropists have conscientiously resisted its ravages upon society in every conceivable manner. Argument, moral suasion, sympa thy, kindness, forbearance, and every variety of moral influence have been exhaust ed upon it. Crusades, prayers, tears, mobs of pious ladies spurred to supra-masculine bravery have boomed above the law, battered down doors, fearlessly entered saloons, and boldly flooded streets and sidewalks with their death-dealing stores, hoping thereby in some degree to mitigate the direful work committed upon the communi ty. Generous liberality has provided homes, retreats, associations for encouraging the unfortunate victims of the vice to assert their self-control and rise from the de bauchery of drunken degradation to the respectability of sober lives. Laws have been enacted for the suppression of the vice by imposing burdens upon the sale of intoxicants in the form of taxes, and prescribing penalties for certain offenses connected with the traffic. But so far all reformatory measures have signally failed to restore primitive sobriety in the community. And, it is said by persons having an opportunity of speaking advisedly in the matter, that drunkenness is as rife to day as it has ever been, if not actually on the increase. The failure of earnest and studied effort to remedy the eveil shown, at least, the stern and difficult nature of the problem. All agree that withholding the beverage, or abstaining from its use, would inevitably secure the desired object. This is a self-evident proposition. Dis couraged by the results of former efforts, and distrusting all methods in which uncertainity is involved, the leading temperance workers adopted prohibition as an essential requirement to remedy this social calamity. Prohibition appears still to be the policy of the more active and ruling element of the temperance party. In regard to the import of the term prohibition, the pass word of the party, there seems to be some ambiguity, if not discrepancy, associated with its meaning, or at least with the scope and details of its contemplated operation in the minds of those identifying themselves with the movement. Some are so ultra in their opposition to alcohol as to allow this one feeling to dominate the entire ) man. They have nursed their all-absorbing topic into a blind fanaticism which dogmatically asserts that alcohol is an unmitigated curse, without any redeeming ) qualities-that it has no useful properties which other remedies and substances do not possess in an equal degree without the liability to produce the grave conse quences of drunkenness. They adopt the strict, literal signification of the term and apply it to the manufacture. Such radical proceeding would effectually wipe out all subsequent effects, uses and relations of the drug in every sense, and summarily close its history. The theory is based on an implied assumption that contact with the drug, as a rule, will corrupt the person, and therefore all should be concluded
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corruptible and subject to the humiliating inhibitory regulations required only for the drunkard. A thousand innocent persons should be made to suffer under this theory, rather than a single scalawag should be whipt of justice-a remarkable doctrine to promulgate in a Christian civilization, a libel upon the morals of the race. This teaching is refuted by facts staring us in the face every day. The pro prietors of saloons are rarely drunkards. Their occupation as retailers require the constant handling of the dangerous thing, and yet there is a remarkable immunity from inebriety among them. Those engaged in its distillation, as well as those em ployed in the various arts, manufactures, professions and sciences requiring its use are rarely demoralized by handling it. The intelligence of this enlightened age will not forego the benefits of an agent of such diversified and in many instances in dispensable usefulness because a few weak-minded and demoralized persons have not the moral power to resist the temptation to use it improperly. Prohibition is not the true spirit of moral improvement in the disposition of an agent of wide and varied usefulness. The interests of the human family prompt to elevation of moral sentiment, the culture and exercise of the noblest elements of our nature. High moral culture should have scope for labor and exercise to the extent of its capa bilities in the realm of useful work. To restrict capacities for a broad field of useful ness to the circumscribed regime suited to the pensioners of public charities would be a ruling unjust in itself and disastrous to the material improvement of the world; a compound of madness and superlative folly. The more considerate workers in this benevolent cause, those of the better mental equilibrium, believe that the traffic in the drug might be so carefully guarded as to prevent the injurious results growing out of its promiscuous sale and use,and yet preserve to society all the benefits of its legitimate applications and uses. This proposition presents itself as the more feasible one, and should form the basis of any law the wisdom of the Legislature may devise upon the subject. It is a foregone certainty, as far as human sagacity can penetrate coming events and history, that alcohol will continue to be made and used for legitimate purposes by the wise and good, in whose hands it is safe and harmless, throwing the vicious phase of the subject into the hands of the law-making au thorities to regulate by the application of such wholesome statutes as may be best suited to protect the weak and reform the vicious from the suicidal and murderous tendency of their own inherent depravity. Drunkenness is a disease, a death-dealing disease, from which statisticians report 60,000 deaths annually in the United States. This appalling mortality occurs chiefly at the end of a chronic struggle, in which a wide wreck of hopes, happiness and fortunes drift upon its horrid wake. Its incipiency is a thoughtless, voluntary act, rather an indiscretion than a crime. The first effect of alcoholic beverage is that of an agreeable stimulus, producing a cheerful flow of feeling, hilarity of mind, elasticity of muscles, running into a merry, jolly play of wit and humor, very enoyable to the vivacity of youth, and not despised by the clever old fellows of riper years. Hence, it is admirably suited to give animation to a little assemblage of friends on convivial occasions. These little social revelries are fascinating to the youthful mind, and were their influence to go no further, no serious objection could be made to them. But beneath their fun and frolic there lurks a dangerous gorge into which the unsuspecting children of sport and gayety are liable to be drawn and devoured. Repetitions of these libations insensibly form a habit. Those who have been betrayed and taken in by them had no idea of becoming drunkards. But while thoughtlessly, and fearlessly, and sparingly, as they thought, indulging in their potations, relying on the potency of their self-control for protection, the fell monster insidiously insinuates and fastens itself upon them.
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A habit called dipsomania, or drunkard's thirst, is formed. They are now under the complete control of a dominating propensity which they have not the moral power to resist. It exists as a condition of the vital organism. The condition is an abnormal one, it is true; one that was born of vicious habits and indulgences; but it is nevertheless a force in the composition of the individual of as great power over his will as any of the normal promptings of nature. He is utterly powerless to resist it. The will is captured and perverted. It is made subservient to the demands of his in satiable thirst for stimulants. The will is the creature of an internal feeling or con scious demand for gratification. The depredation upon the mental constitution not only unfits the man for the duties of citizenship and the more sacred cares and concerns of the domestic re lations, but inspires him with a viciousness of disposition, at times jeopardizing the safety of his family and the public. His imagination is perverted, suspicions aroused, and his manner and general character have become those of thr· drunken sot. The susceptibilities of the nervous system have become deranged and changed in func tion if not in structure. There is sluggishness of the intellect, and much of the time semi-insanity, with now and then intermittent paroxysms of furious mania. The senses become so perverted as to create myriads of horrid images about the pitiable deluded victim, which frighten him into tremors, spasms, and sometimes sudden death. The drunkard is lost to his family, to himself, and to community. He is not only a loss, but a positive burden and scourge in all these relations. He corrupts the blood of his offspring by entailing upon their constitutions hereditary tendencies to inebriety, insanity, epilepsy, and various other nervous and constitutional defects. In the initial stage this disease appears in the form of a simple, social vice, which might be easily abandoned before the habit is formed. After this the case is very different. The inebriate has lost his power to resist the temptation. This does not seem to be appreciated by the sober portion of community. Voluntarily taking the drug seems to invest the act with the idea of crime in popular estimation, and the man is treated as if he had the known will-power to break off from the habit of drinking, when, in fact, he has no such power. I think this class of unfortunate men have not received the benefits of public commiseration their helpless condition deserves. They are evidently the victims of disease which the legislative and judi ciary departments should recognize, not in a vindictive or punitive, but in a liberal and restorative spirit. It has been held by jurists that intoxication should not abate the punishment of crime, but if considered at all should intensify it. That a man who would voluntarily put himself into a mental state by intoxi cating beverages, in which his liability to commit crime is greater, should be pun ished as severely as if he had premeditated the act, and wilfully prepared himself for it by taking the stimulant to nerve himself for the horrid deed, is true. But this is rarely the case with drunkards. When they commit the graver crimes, it is almost always when under the influence of high excitement in a state of intoxication, and under circumstances showing there was no premeditation of the crime. In case of the criminal forethought, on the contrary, he has resolved upon the deed previously, and appeals to artificial stimulants to insure its performance. It is taken as a element of criminal success, dictated by his reason to insure greater certainty of purpose. And again, in case of detection, he may plead unsoundness of mind from intoxi cation as a means of escaping the operation of justice. In this case there is neither insanity nor drunkenness. It only exemplifies a dark, revengeful malice, connected with a high order of intellect employed in executing its hellish design. The alcohol is taken only to stimulate a disregard of the natural impulses of the human heart,
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which might weaken his energy and defeat his purpose to commit the crime. Such persons know how far to use the drug to serve their purposes, and then they cease. These persons are never drunkards. The drunkard has not the craft to deserve the penalties due to such crimes. There are but few, if any, chornic inebriates who have not made earnest efforts to reform their lives. They are by no means ignorant of the fearful direction in which they are drifting, and put forth every effort they are capable of making to escape the gulf into which it must unavoidably plunge them. They resolve and vow, over and over, never again to swallow a drop of intoxicating fluid. But it is not long before an exacerbation of dipsomania attacks and overcomes them, and they are found with their cups again. When exhausted by the debauch, and they are languid, sour and relaxed, with nausea and headache, and all the train of bad feelings that fol low what drunkards call a "good time," unbidden thoughts bring to remembrance broken vows and promises, lighting a devouring remorse upon their troubled con sciences, literally overwhelming the pitiable creatures in gloom and despondency. Yet the noble instincts of the human soul are not wholly obliterated. When the storm of bacchanalian carousals subsides, reason, conscience, respect for an up right life, with a desire to enjoy its reward, spontaneously react. Individual effort on the part of the victims of intemperance to reform them selves, and that of earnest, benevolent temperance workers to aid them in the noble undertaking, have probably filled the measure of their success as fully as they ever will or can. These efforts, as we have seen, have been rewarded in lamentable and discouraging failure to achieve their laudable aims. The resources of municipal authority have been only sparingly and empirically experimented with. Its capacity as a remedial agent has never been thoroughly tested. Laws have been enacted at various times by our Legislature professedly intended to regulate the sale of ardent spirits, and to prevent intemperance in their use. So far, however, they have done but little good in the way of promoting sobriety or repressing drunkenness. They have usually been so vague in their terms, or their enforcement so feeble, as to enable those engaged in the traffic to easily evade their penalties-the license to retail being the principal burden encumbering the trade. As the retail business is recognized as a legitimate industry, it should be held responsible for all damages growing out of its business transactions. Injuries to persons or property of the inebriate's family and others-the loss of his time and services to his family, in consequence of the mental inequilibrium caused by the drug sold him, should be compensated for. This reponsibility should be made valid by bona fide bondsmen of assured solvency sufficient to cover all probable damages that are liable to occur. The saloon industry is uncalled for by the real necessities of com munity. It derives its support almost exclusively from the unnecessary, and even injurious, consumption of his (the saloonist's) merchandise. The real desiderata of health and hygiene do not require large stores of stimulants, and when needed for medical purposes they are obtained from the drug store. Then, in view of the stu pendous evils which flow out of this fountain of pestilence and prey upon the moral, social and material interests of society, in connection with the fact that for all medicinal purposes stimulants can be readily obtained in drug stores, their sale as a beverage should be prohibited by the strong arm of the law. Such wise regulations of the traffic as may adapt it to the wants of the people would contribute immensely to improve the present deplorable condition of our civilization in its relations to alcoholic inebriety. That the intellect and judgment of the inebriate are so distrubed during the exacerbations of his malady, as to render him incapable of transacting the business
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of his avocation, upon which his subsistence and that of his family depends, is a patent fact, doubted by no one. After the habit has been formed the inebriate has not the power to resist it, is another fact, with a few rare exceptions, equally sub stantiated. In this view of the subject, the duty of the State to take care of and provide for the restoration of confirmed inebriates is as morally binding as it is to extend similar charities to the insane from other causes. The inducements to benevolence are even greater, as desirable results are more promising. The asylums have been much more successful in reforming inebriates than the organized temperance workers. The latter, it is said, have succeeded in reforming ten per cent of those taken under treatment by moral influences, while the success of asylums has been thirty-three per cent. Those treated in the asylums are thought to be of the better class. They go volun tary and submit themselves of their own volition to treatment from a desire to ob tain a cure. A serious detriment to the success of the e institutions is said to result from the imperfect control the management has over the patients. Being voluntary, the patients exercise the right of leaving whenever they please, and also to be consulted as to restrictions placed upon their treatment. Under these conditions absolute prohibition can not be enforced, and in many cases it is a sine qua non to the cure. This is a disease in which the judgment of the patient is exceedingly liable to err, and the right of determining the treatment to be employed, and also when the cure is complete, should be delegated to a competent person in the management of the institution. These embarrassments to successful treatment would not be in the way in a State charity; and in almost all cases the patients would become restored by perfect inhibition of the offending drug. The term required to effect a cure would vary according to the hold the habit had gained upon the system and the inherent will power of the patient to conform his habits to the dictates of a correct judgment. A law embracing the main features of temperance work herein imperfectly shadowed, well matured in its details, and vigorously enforced, would guarantee to the inmates of the asylum all the benefits of prohibition which this potent remedy has in store for the drunkard. It would also have the most salutary hygienic effect of arresting many incipient cases before developing into mature inebriety.
DISEASES PREVALENT IN THE EARLY SETTLEMENT OF KOKOMO.
C. RICHMOND, M. D., KOKOMO, IND.
The first settlement made in Kokomo with a view to the building up a town, ·was in the spring of 1845. A number of individuals came upon the ground selected for the site of the future capital of the county, in the fall and winter previous, for the purpose of building cabins or log houses to put their families into when spring opened. The incidents, exposures and hardships attending the first settlement of this place were such as most generally attend the first settlement of all new places. And although the hardships amounted to considerable, yet there were many things calculated to soften their severity, and the people were enabled to bear them with commendable grace and a good deal of fortitude, and in many things really to find enjoyment. But I do not propose to give a complete history of every matter con nected with the first settlement of the county or town. I shall only introduce so much as will, to some extent, show that the tendencies were faborable to the de-
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R131 Al_IS_VS_N02_012 DISEASES IN KOKOMO
velopment of a certain disease, the character of which disease I have in mind mainly to consider. The site for the town was donated by David Foster, and was laid off into lots by direction of the county commissioners, and the first sale of lots occurred October eighteen, 1844. The ground was then covered with a heavy growth of timber and under-brush, quite flat, especially on the north side. From the middle of the public square on the north side and running west, it was quite wet and swampy; it has since been filled up and does not appear so bad as formerly. In the spring, when the settlers began to clear off their lots, a great amount of timber was cut down; the logs, brush and trash were left upon the ground to rot. About forty acres of ground were thus, for the first time, exposed to the action of the sun during the hot season. The ground was in very bad condition to be thus exposed, without the addition of the more recent incumbrance of the fallen timber. Little or no attention was given to clearing off the ground, except so far as each one wished to enclose for a garden spot, which was speedily dug up to be in readiness for planting. The winter and spring of 1845 was not wet, yet the low, flat ground was quite wet and soft. After the first of April, we lived comfortably and pleasantly; the crevices in the walls of our houses affording ample ventilation, as well as opportunity for observing anything going on outside the house. Vegetation came on early, and gave fair promise of many comforts to the new settlers, which encouraged them to think that a bundant crops were likely to be the reward for all their labor and privation. The indications were, that we had located on a productive soil, and that our county would, as it has since proved itself to be, one of the best counties in the state for agricultural purposes. As time rolled on, and the fall season approached, the result of our operations in fixing to build up a town, began to develop. It was soon noised around that some certain person had ague; next day some one else had it, and perhaps the next day four or five others had it; and some were attacked with remittent fever. It soon began to look rather discouraging, and many of us as good as repented having come here; but here we were and could not get away. Cases multiplied until whole families were prostrated, with none to care for them, only as some neighbor on his well day, would crawl around as fast as he could, and do what he could for them. In some families it was a little better arranged so that they were not all sick in bed the same day, but alternating so that they could attend on each other. The cases continued to multiply, until there was scarcely an individual in the place that was not sick. In the settlements through the country, they were in much the same condition that we were in town. From this condition we did not fully recover, until sometime in the winter following, some quite late; but finally about all were what we called "well .of the ague." Very few deaths occurred this season. As the ague disappeared, a disease began to develop that was entirely new to most of us. We were told that it had prevailed in various sections of the Wabash country on its first settlement, but after a time had disappeared. As to any authentic history of this disease, I have never seen any, and only know it from having seen it in a great many cases, as well as having had it myself. The first intimation of the attack was generally a slight soreness in the throat, which was soon followed by a sensation in the mouth and especially upon the tongue, similar to that experienced after taking a mouthful of coffee or some other fluid that is too hot. This sensation was slight in the commencement and gradually increased in intensity until it became quite unpleasant. In most cases the discharge
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of saliva was increased considerably, in others, rather diminished. The interior of the mouth and fauces became reddened; the tongue generally appeared smooth as though the mucous membrane had slipped off, taking the papillae with it; deep fissures formed in the tongue that appeared to extend through half its thickness. These appearances were about all that presented in many cases, only rendering the person uncomfortable, especially while eating, which caused a good deal of pain. Every article of food of a solid character would feel as though there was an unusual roughness about it, rendering the process of eating very unpleasant and annoying. In other cases, soreness and excoriations made their appearance at the angles of the mouth; the diseased condition of the fauces extended to the palate and thence into the nose, making its appearance at the opening of the nostrils, where we had about the same appearances that are witnessed in scarlatina. Ulcers formed in side the mouth, in some cases, that occasionally presented a dark appearance. This diseased condition of the mucous membrance in some ca.>es extended to the stomach and bowels, traversing the entire length of the intentines, and appE.·aring externally at the anus, with excoriation of the surface, often quite extensive. This condition or extension was mostly confined to young children, and caused the death of several. Little children suffered greatly with the disturbance of the stomach and bowels, in some instances protracted for weeks. Often the eyes became affected, and took on the same appearance that the nose and corners of the mouth did. In most of the adults who had any extension of the disease beyond the mouth, the genital organs were included, taking on the same inflamed, sore condition as existed in the mouth and nose, often causing the falling off of the hair from the surrounding surface, cracking of the skin in various directions, forming scales and discharging a glutinous fluid, accompanied by excessive itching, often to such a degree that no sense of modesty was sufficient to restrain them from scratching when the itching com menced. The scratching would be followed by pain and smarting. Some were troubled with phimosis, which was very annoying; the diseased condition of the skin extending to the scrotum, causing cracks, the edges of which would turn out and project, so that in walking these edges would catch in the clothing and cause a very disagreeable state of things. There is still another feature of this disease, that perhaps would more correctly be regarded as a sequence of what has gone before. In quite a number of instances, as the diseased condition of the mucous membrane began to recede, and recovery seemed to be promised in the near future, the feet became affected. This, which at the first appearance of it was slight, soon grew to be very distressing, and was often very painful, and yet the feet presented no external signs of disease, but appeared natural in all respects. The pain was severe in the ball of the foot and toes, and was of a burning character, necessitating the removal of all covering from them, both day and night. This only mitigated the suffering, but did not stop it. The only treatment that gave relief was opium. With regard to the cause of this disease, I am unable to give any opinion. The predisposing cause was doubtless the condition in which most persons were left by the previous fall's sickness. Some claimed that the constant use of salt pork was the cause; others thought that coffee was the cause. It was claimed by others that as soon as they could get milk and use freely of it, the disease would leave them. In the spring, as a general thing, milk was used freely, less meat and coffee were used, and as the season advanced they generally got better. I am inclined to think that its subsidence was owing more to the change of season, than to the diet, for many persons who· had milk and used it freely every day, had the disease as bad as many that had no milk. It prevailed mostly in the winter season.
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A great variety of treatment was adopted. Many relying upon their own in genuity and experiments treated themselves; others applied to physicians and submitted to their directions. All the ordinary local remedies for sore mouth and throat were used in succession, with variable results. Pregnant women generally suffered more than others, and some few of this class died. These and a few children were the only deaths. During the following summer, most of the afflicted got apparently well. Some had it all summer, but much milder, and as winter returned, there was a return of the disease, but much less severely than before. Those who had the trouble in the feet were the last to get well. With some it continued more or less severely for two or three years, and gradually left them. I am not aware that any thing of the kind has since occurred in the county. If it has, it has been in a greatly modified form. During the summer and fall of 1846, we had about the same variety of diseases that prevailed the previous year, with the addition of a few cases of congestive intermittents. For the first six years after the settlement of the county, the sickness was mostly confined to the vicinity of the creeks no doubt because the first and princi pal settlements were made along and near them; afterwards extending out into the back country. Yet this was not the only cause. On Kokomo creek the first settle ment was quite healthy; but as the farmers cleared up the land along the creek, quantities of trees and trash were thrown into it to get them out of the way; in this manner the creek was greatly obstructed, and that, too, by decaying matter, that would be prolific of the cause of disease. The result was, a great increase of sickness in that vicinity. The same thing occurred in other localities. But this condition of things has about passed away. During the winter of 1846 and 184 7, there were some cases of scarlatina, a few of them of malignant form, some of which ended fatally. Cases of pneumonia of a typhoid character occurred this winter, not, however, attended by anything unusual. In March and April, 1847, a number of cases occurred that were unusual; such as I had never seen, and of which I could not at that time get any account. It was thought by some, that the symptoms indicated malignant erysipelas. The cases were sufficiently malignant for that matter; for, of twenty-two cases, all died, except two. Cases bearing some little resemblance to these, recovered; but of the well-marked cases, the above was the result. Some of the severest cases run their course and ended fatally in from six to eight hours; others run from two to four, or six days, and one or two, to two weeks. The malignancy of this disease caused quite a panic in the community; so much so that the immediate neighborhood was left, in a great measure, to take care of itself; a few persons from town, nobly doing their duty in attending the sick and dying. All the above cases occurred on Kokomo creek and Pete's branch; a strip of land not over two miles in length and half a mile wide, and immediately south from Kokomo. The attack was ushered in by a chill of more or less severity and duration followed by fever, which generally ran high for a short time accompanied by de lirium. Soon after the fever set in, there appeared a number, sometimes a great many, bright red spots of various sizes and shapes, slightly elevated, tender to the touch, with general swelling and tenderness of the integument, extending over the entire person. The red spots, after a short time, turned to a bright purple color, surrounded by a bright red line. Where the chill ended in collapse, the eruption generally appeared, but assumed a dark or brown color, without the red margin. But one case, in which the eruption appeared, recovered. In that, the spots sloughed out, leaving a deep, irregular sore
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that was hard to heal. This case was less severe than usual, but the swelling of the body and the tenderness were considerable. In most cases of collapse, the force of the malady seemed to concentrate upon the lungs; the breathing soon became laborious, with manifest accumulation of mucus in the lungs and air passages, which, in the agony of dying and spasmodic contraction of the muscles of the chest, would be discharged by the mouth in great quantities-enough, apparently, to produce suffocation. A few cases that were not attended by the eruption presented head symptoms, as in inflammation of the brain, attended with high fever, furious and persistent delirium, terminating fatally in eight or ten days. One case only of this class recov ered. In this case, after recovery, there was a decided deformity of the face, which was permanent; also, some permanent difficulty in the spine, which ultimated in paralysis of the lower extermities. The treatment adopted was founded upon the appearances that presented themselves as they were seen. Several received no treatment at all, running their course in so short a time that death was at the door before the danger was realized. Cathartics, mercurials, quinine and palliatives were used in all that received any treatment.
Indiana Historical Society Nonprofit Org. Indiana Medical History Quarterly U.S. Postage 315 West Ohio Street PAID Indianapolis, IN 46202 Indianapolis, IN Permit No. 3864
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R131 Al_IS_VS_N02_016 W-A - ^ 3 S(p -wi INDIANA HISTORICAL SOCIETY Volume V Number 3 September, 1979 R131 _A1 _l 5_V5_N O3_001 The Indiana Medical History Quarterly is published by the Medical History Section of the Indiana Historical Society, 315 West Ohio Street, Indiana polis, Indiana 46202. MEDICAL HISTORY SECTION COMMITTEE CHARLES A. BONSETT, M.D. Chairman and Editor 6133 East 54th Place Indianapolis, Indiana 46226 JOHN U. KEATING, M.D. 8415 Washington Blvd. Indianapolis, Indiana 46240 KENNETH G. KOHLSTAEDT, M.D. 645 East 80th Street Indianapolis, Indiana 46240 BERNARD ROSENAK, M.D. 5 254 North Delaware Street Indianapolis, Indiana 46220 DWIGHT SCHUSTER, M.D. 4503 Washington Blvd. Indianapolis, Indiana 46205 WILLIAM M. SHOLTY, M.D. 1831 Lilly Road ^ Lafayette, Indiana 47905 W. D. SNIVELY, JR., M.D. R.R. 1, Box 277 Evansville, Indiana 47712 MRS. DONALD J. WHITE 3524 North Meridian Street Indianapolis, Indiana 46208 The Committee invites the contribution of manuscript material relating to the practice of medicine in Indiana — letters from or to physicians, diaries, case books, etc. Identified pictures of 19th century Hoosier doctors or medical meetings are also being sought. Objects relating to medical practice are desired for the Museum. Please write to Dr. Charles A. Bonsett, Chairman, Medical History Section, Indiana Historical Society, 140 North Senate Avenue, Indianapolis 46204. Cover: Dr. Thomas, prominent female physician, practiced medicine in Richmond from 1856 to 1888. L______R131 A1 15 V5 N03 002 IN THIS ISSUE Dr. Mary F. Thomas is the subject of this issue of the Quarterly. Mary Thomas, a 19th century Hoosier physician, attended medical school at a time when it was an unnecessary formality in order to practice medicine in Indiana and also at a time when it was considered very un-ladylike. She was born Mary Frame Myers on October 28, 1816, in Montgomery County, Maryland, near Washington, D. C. She died August 19, 1888 at her home in Richmond, Indiana. The following biographi cal material is from the Richmond, Indiana, newspapers of the day (The Richmond Telegram and the Evening Item). Dr. Thomas’ death was a front-page story. (We are indebted to the Richmond Public Library for their help with this issue). The parents of Mary Thomas belonged to the Society of Friends, and had lived in Berks and Chester Counties in Pennsylvania before moving to Maryland. Her father, as would be expected of one of the Quaker faith, had strong feelings against the institution of slavery. He participated with Benjamin Lundy in organizing and attending the first anti-slavery meeting ever held in Washington, D. C.—an activity that was neither popular nor safe at that particular time and place. While living near the nation’s capitol, Mary had occasion to hear the con gressional debates, sitting with her father in the visitors’ gallery. Because of the slavery issue, however, the family moved West to a farm in Columbiana County, Ohio. During the summer months she would assist her father with the farming, and in the winter months he would be her tutor, providing all the instruction of which he was capable. In July, 1833 she married Dr. Owen Thomas, who then became her preceptor in medicine. She attended a course of lectures at the Female Medical College of Pennsylvania in 1851-52, and in 1852-53 attended the course of lectures at the Cleveland Medical College. In 1854 she received the M. D. degree from Penn Medical University for Women at Philadelphia. The Indiana Medical College commenced in 1869. Mary Thomas and two other women attended this first session of lectures, and apparently they were not without harassment. Some of the male sex thought that medical school was no place for the female. Others were without prejudice. Dr. Mary Thomas felt that prejudice also existed in the practice of medicine in Indiana, and that certain discriminations were evident against the female practitioner. Reproduced in this issue of the Quarterly is a paper which she read before the members of the Indiana State Medical Society at their annual meeting in 1883: “The Influence of the Medical Colleges of the Regular School of Indianapolis on the Medical Education of Women in the State.” She presented other papers to the Society, three of these urging the use of female physicians for female patients in hospitals for the insane. —— (Readers of the Quarterly, who also read The Diary o f Calvin Fletcher being- published by the Indiana Historical Society, and who are current with Volume VI, will recognize the name of William B. Fletcher, Calvin’s seventh son. Volume VI of the Diary completes the year 1860. At this time William B. has just completed his medical education, and has opened an office for the practice of medicine. After the Civil War, he will study in Europe and will become interested in neuropsychiatry, ultimately becoming Superintendent of the Indiana Hospital for the Insane. Dr. Fletcher wholeheartedly endorsed the concepts of Dr. Mary Thomas, and as Super intendent of the Insane Hospital does employ a female physician, Dr. Mary Angela Spink, to care for the female patients. Dr. Spink later assists Dr. Fletcher in the operation of his own private mental hospital, “Neuronhurst,” which she manages alone following Fletcher’s death). 3 R131 A1 15 V5 N03 003 4 INDIANA MEDICAL HISTORY QUARTERLY The Thomas’s practiced medicine in Fort Wayne for two years, and then moved to Richmond in 1856, where they lived until Mary’s death in 1888. Dr. Mary Thomas tried twice to join the Wayne County Medical Society, but was denied membership because of her sex. She was ultimately admitted to membership in 1875, and in 1876 she became the first female member of the Indiana State Medical Society. She was apparently a tireless worker. Kemper, in his Medical History of Indiana, has only praise for her “. . .A faithful worker in everything that aimed to make the human race better.” Dr. Mary Thomas was one of the prime movers in establishing a women’s prison and a girls’ reformatory in Indiana. She was also an early advocate of women’s suffrage. In 1858 (with Agnes Cook and Mary Birdsall) she read the following resolution to the State Legislature—“To the Honorable Senate and House of Repre sentatives of the State of Indiana: The undersigned residents of the State of Indiana respectfully ask you to grant to women the same rights in property that are enjoyed by men. We also ask you to take the necessary steps to amend the constitution so as to extend to women the right of suffrage.” This petition, signed by more than a thousand persons, did not move the legislature. At this same time Dr. Thomas was editor and publisher of a paper, “The Lilly,” devoted to the subject of women’s rights. She was also an active abolitionist. Dr. Mary F. Thomas was an exemplary physician. She scored equally well as a wife and as a mother (three daughters). In her eulogy she was described as . .a womanly woman. Without being aggressive she pursued a modest, straightforward method of meeting all difficulties. . .” It is of interest to note that early in her career she managed not only to study medicine and to attend to other interests but also to attend to her own house without help and to make her own children’s cloth ing without the aid of a sewing machine. She commented, with reference to this, “I found the most vigorous discipline of my mind, and systematic arrangement of time indispensable.” She was undoubtedly a very remarkable woman. INTRODUCTION The fundamental question is whether a woman should ever examine and treat a man other than her own husband. Throughout most of the nineteenth century public opinion was strongly opposed to the idea of a female physician, and medical schools therefore denied admission to female applicants. It is of interest that Quakers who customarily seated the sexes separately in church saw no more impropriety in the female treating the male than in the male treating the female. The Quakers were a strong influence in overcoming the general prejudice against educating women to become physicians. In Philadelphia in 1850 the Female Medical College of Pennsylvania, supported largely by Quakers, commenced operation. A second school which existed for only a few years, the Penn Medical University was started in 1853, this having both a male and a female department. This school was inaugurated by two physicians, one of whom, Dr. Joseph Longshore, had been a founder of the Female Medical College of Pennsylvania. (In 1867 the name was changed to the Women’s Medical College of Pennsylvania). Dr. Mary Frame (Myers) Thomas received her M. D. degree from the women’s department of the Penn Medical University in 1854. She had two half sisters who taught in this school, Dr. Jane Viola Myers and Dr. Hannah Myers Longshore, sister- in-law of Dr. Joseph Longshore. I______R131 A1 15 V5 N03 004 MEDICAL EDUCATION OF WOMEN 5 TH E INFLUENCE OF TH E MEDICAL COLLEGES OF THE REGULAR SCHOOL, OF INDIANAPOLIS, ON THE MEDI CAL EDUCATION OF THE WOMEN OF THE STATE. BY MARY F. THOMAS, M. D., RICHMOND, INI). Mr. President and Members of the State Medical Society: The action of the colleges of the regular school of medicine of Indianapolis, in excluding women students, has been the subject of much discussion and, no doubt, honest difference of opinion, and believing good will result from comparison of views, I ask your attention to a few thoughts in that direction. It may be considered that medical colleges (when not depart ments of State Universities where co-education is established,) are to some extent private institutions, and therefore subject to the control of the officers in admitting students. While according to them such privileges of selection, as per tain to these vested rights, there are circumstances, a mutual relationship of society looking to the public spirit of education that seem to imply obligations, that institutions of learning owe to the communities in which they are locate’d, that in a measure modifies the strict rules of admission that otherwise might be observed. The spirit of liberality that pervades the educational senti ment of the times, is asking the removal of the restriction of sex, in the reception of students, and qualification and adapta tion for the positions sought in the higher literary institutions is made the test of admission, and we see no just reason why the same course should not be adopted in medical as in other colleges. R131 A1 15 V5 N03 005 INDIANA MEDICAL HISTORY QUARTERLY 6 The science of anatomy and physiology is taught in public schools to mixed classes without complaint of its unfitness by teachers or pupils; also, the science of botany was objected to some, but now we hear nothing about impropriety in the case. It has long been a matter of study to the intelligent, con sistent reasoner on the subject, to reconcile the practice of the profession with the persistent objection to co-education in medicine. Many men physicians honestly deem it improper, if not positively indelicate to talk to mixed classes on the different organs of the body, and their functions in health and disease, and yet see no objections to being specialists in gynecology, and visiting women patients under any and all circumstances, that they think necessary as their professional advisors. Neither do they object to professional attendance, on whole institutions of women, where disease in all its forms comes before them for treatment, no matter how objectionable to the sensitive nature of refined womanhood. Neither does society object to physicians in their capacity, and it being the admitted preroga tive of the attending physician to possess himself of every rea sonable means of diagnosis for the purpose of curing his patient. Personally we have no criticism in regard to the mat ter, but we are reasoning from the standpoint of the professor and students who are so very sensitive about co-education in medicine, that one would suppose they would shrink from obstetric and kindred practice. But we don t find it so in prac tice, therefore their objections are not consistently sustained by their actions. The same objections might be urged to women physicians being members of medical associations. But for several years these have been admitted to all the privileges of membership in these societies, in the transaction of the busi ness without any unpleasant results from tnis piofessional con ference coming to our knowledge. And not only this, but physicians’ wives are frequent welcome visitors to the sessions of these medical meetings, and attentive listeners to the discuss ions, and there is no evidence that anyone feels a repugnance to their presence. Now we have tried to get at the foundation of the objections, with as much justice and good sense as possi- R131 A1 15 V5 N03 006 MEDICAL EDUCATION OF WOMEN 7 ble, and have found that objections are rarely made to the presence of women except where they are likely to come in for a share of the emoluments of the profession, and this is not a valid reason, because neither men nor women will succeed as physicians unless they have natural taste and adaptation to the profession. They can not obtain these in medical schbols, and it will be no professional demerit to educate women, for if they can’t be physicians (as has been charged) the fact will soon be proved—they will fail in practice, and consequently drop out of the profession, injuriug no one so much as themselves, and hence, will cease to knock at the doors of the medical colleges. I am aware that medical students can conduct themselves in such a manner that women students will feel it a compromise of their own self-respect to attend lectures with them, but this is largely in the power of the professors to control. , It was the privilege of the writer, in company with two other ladies, to attend the first course of lectures in Indiana Medical, I think in 1869-70. All went on very pleasantly the first two months. After this a half dozen students thought “ the women had no business there,” and for a few days took every opportunity to annoy us in many ways. Thinking it would pass over, we took no notice of their rudeness, until an anony mous letter was sent us threatening more serious disturbance if we did not leave. This we handed to one of the Professors for inspection. The same day as we entered the class-room, the half dozen gentlemen gave a rather subdued hiss, but it caught the ear of the Professor of Anatomy (who is an honored mem ber of this Association), he stopped and looked up with an expression that attracted the attention of every member of the class, and made a hush all over the house, and these rowdies understood he was in earnest when he said, “ We want it dis tinctly understood, that every student in this class has paid their matriculation fee, and each is entitled to all the rights of every other student of this college, and we shall not tolerate any repetition of this occurrence.” The Professor who had the anonymous letter echoed the same sentiment—this, with the hearty concurrence of a few manly, honorable students, settled the whole matter and there was no more disturbance. And in R131 A1 15 V5 N03 007 8 INDIANA MEDICAL HISTORY QUARTERLY- looking back to the action of the colleges in Indianapolis that have since refused women students on the ground of unworthy conduct of some of the students, the disinterested observer would remark it would seem to be more just legislation to have expelled those guilty of improper conduct, whether men or women students, rather than encourage the men in a spirit of lawlessness, by refusing women students, thus, whether intended or not, throwing the burden of the disturbance on the women, and evading the opportunity thus offered of maintaining the good order and usefulness of a chartered institution of learning, which, when rightly conducted, is always an honor to the com munity wherein located. Instances are not wanting where refractory students have been expelled from literary institutions with beneficial results, and there is no good reason why the same course would not have a healthy influence in medical colleges. A friend of co-education says there will always be a few “ coarse, rough men students that refined women will shrink from, in medical classes.” We submit the question, whether such “ coarse, rough men,” are fit to be physicians ? I believe one of the requisites for graduation is moral character of the applicant, and if this class of men were made to feel that they could not receive the honors of the medical college, it would certainly have a good effect in promoting the morals of the student. But it is said, “ young men will not attend lectures with women, and we can not sustain these colleges financially.” This is a phase of the question that merits careful considera tion. I believe no class of men are more justly noted for benevo lence and philanthrophy than physicians, and yet these can not be expected to carry the burdens of medical colleges without compensation. If this is really the fact at the present, we can’t help but feel that they can be educated out of this narrow pre scriptive feeling, and if a few of this class refuse to attend mixed schools it will have the effect to purify the ranks of the profession by leaving out the “ coarse, rough class,” and we believe better men will take their places. The Dean of Baltimore Medical College, where women have R131 A1 15 V5 N03 008 MEDICAL EDUCATION OF WOMEN 9 been received, says: “ We believe we started out in the right principle, but must yield to the pressure for the present, yet, we have practical demonstration of woman’s equal capability of acquiring knowledge of the healing art with men, and our women graduates are rejoicing at the privilege of having been educated and graduating with equal honors with the other sex ; but for a time, at least, we must not receive women students until we can get started on a firmer financial basis.” This frank statement of facts merits our highest appreciation; and yet, while regular colleges are waiting for the necessary devel- ment of public sentiment, colleges of the other schools are educating women (two in Indianapolis, this past winter, admit ted women), and thus placing them under the necessity of being irregular whether they wished to or not, and this answers the , question asked a short time ago: “ Why are so many of your women doctors quacks?” (I do not like the term but give it as given at the time.) If the regular accredited medical schools push them out of the ranks, they will, of course, seek admis sion to other colleges. One excellent young lady of Wayne county is studying in a Homeopathic college, because she has better facilities than at home. One says, “ I don't know what you want when there are separate colleges for women.” These col leges are no doubt very good, so far as they can reach the class of women students, but all can not go to Hew York, Philadel phia, Chicago or Baltimore, and these are all the separate medi cal colleges. As a further argument on this point, it is within the mem ory of many of us, when co-education was thought highly improper in the higher literary institutions, and some objected to it in our common schools, and yet this prejudice has passed with years, and the Indiana State University has the honor of the first State University to graduate a woman (I think in 18(iO), since which time co-education has been established in the Michigan University, Cornell, and many of the leading state institutions. I take great pleasure in citing the following from the Secretary of Fort Wayne Medical College: he says, “ We still receive lady students, and shall continue to do so, as long as the College remains in the hands it has been, and still is in.” R131 A1 15 V5 N03 009 10 INDIANA MEDICAL HISTORY QUARTERLY The small number of women attending medical colleges is urged as an objection, in a financial point of view, but Michi gan University, at Ann Arbor, that has steadily opened its doors to women longer than any other medical institution, is conclu sive answer on this point. Their Professor of Obstetrics says, “ Co-education has been in operation in this institution about twelve years, and has worked satisfactorily and successfully, much better indeed than was anticipated. Ho trouble has grown out of the association of the sexes in collegiate work. We have graduated from twelve to fifteen yearly, in the medical department, which has always had the largest ■proportion of women students, the average attendance being from 35 to 50. The experiment here'may he con sidered a success, and firmly established.” Thus, the financial objection has been tested in this institu tion to the satisfaction of all parties, and as co-education in more of the best literary colleges is found to be productive of better results than separate schools, so, I believe, in rightly gov erned medical colleges, the influence of each sex will be quite as beneficial. If women physicians were always expected to con sult with women alone, and not meet men, either in the capa city of physicians or patients, there would be more reason in seclusive medical schools, but as such conditions are neither practical nor desirable, it will be more in harmony with our social relations, for medical colleges to admit persons of moral character who pay their matriculation fee, and conduct them selves as become those who seek the knowledge thus gained for its own sake, and as a means of benefiting themselves and others, rather than attempting to settle the question, whether men or women can, or ought to be, doctors; this question has settled itself, and society has accepted the verdict. On this phase of the question the faculty of the Baltimore Medical College says : “ Women have, in all ages, successfully practiced medicine and midwifery, and in our own day they are able to compete with other regularly qualified practitioners.” In connection with this thought comes a vivid recollection of an incident that occurred twenty-five years ago, in the experi ence of the writer, that I trust you will pardon me for intro- R131 A1 15 V5 N03 010 MEDICAL EDUCATION OF WOMEN 11 ducing here, as it seemed to me at the time almost an insur mountable difficulty. Having a very serious case in an old lady, that caused great anxiety, I asked an experienced and very reputable physician of the regular school for consultation. He replied “ No, I can’t do it! because a woman can’t be a doc tor! and I should compromise my professional character by acknowledging you as such.” Turning away, depressed in spirit, I said, is it true that I have undertaken what must be a- failure, not for myself alone but other women, younger in life and with less care and better opportunities, all to be a failure? “ Women can never be doc tors,” sounded all along the pathway of these women; still they studied and practiced, feeling that at least they were mak ing the way possible for others to walk in, until, thanks to the progressive magnanimity of the profession, women have been admitted to membership in the highest medical association in the land, proving beyond cavil, their recognition by the regu lar profession. But though they have been practicing successfully in this country more than a third of a century, an honorable and learned professor for whom we have the most profound respect, comes out recently in an eloquent doctorate address, takes the ideal words of two centuries ago for his theme, and defines the physician “ a good man skilled in healing,” forgetting the fact that even at that time there were many women skilled in heal ing. Among a host of honored names of women physicians of that day, Madame La Chapel and Madame Boevin are recorded on the pages of medical literature, as bright examples of pro fessional triumph. While thanking him very cordially for his kind words with regard to good women of the present day, who are skilled in healing, we suggest the present acceptation of physician is, a person skilled in healing, and I have serious doubts whether these good women will feel called upon to accept his eloquent entreaty to pause in her work in the pro fession. The time is past for women who have tasted at the ■well-spring of life, to go back, notwithstanding the impressive earnestness with which he entreats her to refrain from the hardships of the profession; she has already’settled that question R 131 A1 15 V 5 N 0 3 O i l 12 INDIANA MEDICAL HISTORY QUARTERLY for herself, and society endorses her position by giving qualified women physicians constant employment, and experience is proving that the hardships spoken of are not at all insurmount able. It has long been the custom, where one physician is called at night to attend a patient, one or two women are called to assist him, and these seldom complain of the hardship. Indeed, we believe the health of the busy, successful women physicians of twenty years’ practice will compare quite favor ably with their professional brethren, and thus we find that those persons whose minds are thoroughly imbued with the grandeur of God’s creation, and regarding the human mechan ism as the emanation from Deity, and where not cramped and dwarfed by false custom of society is the embodiment of the perfections of physical and spiritual purity, and especially is it meet that persons who essay to deal with these life prin ciples, should make themselves, as far as possible, co-workers with nature, in endeavoring to bring up the human family to the highest point of development to which human beings can attain. And if the physician realizes the dignity of the pro fession, that it can not be prostituted to mere mercenary pur poses, they will be lifted above all sordid considerations, and as teachers and pupils of the science of human life, embracing alike preventive and curative treatment, they will have no disposition, nor find time, to discriminate in favor of one sex or the other in medical classes; and the student who comes be fore them for instruction will be so thoroughly impressed with the sacredness of the calling to which he or she aspires, that all minor considerations will be lost sight of, and those who can not attain to the position opening up to them as physicians, will pass down and out, whether men or women students, and thus if the standard of moral and physical purity is held up by those having it in charge, in accordance with its importance, these matters will adjust themselves harmoniously, and enlight ened society, ever true to her highest interest, will have no harsh discord; and to bring about this desirable result should he the aim of every intelligent, liberal-minded physician, whether man or woman. R131 A1 15 V5 N03 012 MEDICAL EDUCATION OF WOMEN 13 DISCUSSION OF DR. MARY F. THOMAS* PAPER. Dr. Pearson, of Indianapolis.— Mr. President, holding the position I do in one of the colleges referred to, it is fitting I should say something on this paper. I never denied women any privilege whatever, and I think they will testify that in all gynecological and clinical practice I gave them equal opportu nities with male students. In reference to excluding them from the College of Physicians and Surgeons, of this city, it was not done on account of the hostility to women, because no true man can be hostile to women. The only question was the financial question. I felt that the college, just starting, with the numerous colleges there were in the land, and knowing there was a decided opposition to female physicians in the pro fession, it was against the financial interest of our school, and that was the only question in my mind. The school was young and struggling with other schools for existence, and as a matter of course we had to consider the financial questions in carrying that school along. I had a mother who recently died. My love for that mother, if no other reason, would cause me to love women, and I respect them, and whenever I see woman struggling against the vicissitudes of life, and en deavoring to prepare herself to fill an honorable position, I lift my hat to her always. I am proud to say there is not a col league of mine, that I know of, who stood up in opposition to the admission of females into Central College, but upon the ground that it was life or death to the college. Dr. Harvey, of Indianapolis.—Mr. President, personally I am in favor of the medical education of women; yet I do not think that men and women can receive medical education at the same institution and time in this State at present. The loss in male students, were co-education tried, would not be repaired by an increased number of women students. Finan cial considerations alone induced the Indiana Medical Collegre to exclude female students. Philanthropy and sentiment are good things, but medical colleges are necessarily run upon a business and money basis. R131 A1 15 V5 N03 013 14 INDIANA MEDICAL HISTORY QUARTERLY Dr. Eastman, of Indianapolis.— Mr. President, I think it unjust to the medical colleges of Indianapolis to*have it stated here that women at Ann Arbor have equal advantages with male students in the University of Michigan. It is expressly stated in its announcement that they have a department ex pressly for women. It was that very point in the college to which I am attached—an attempt to make an additional de partment for teaching anatomy and certain other branches— that brought up the financial question, and inasmuch as the strong, healthy institutions have separate departments, entirely equal, for female students, I think it is only right that these statements in the paper reflecting upon our colleges should be met. I, for one, welcome woman to the profession, providing, only, that she, as well as man, has sufficient mental capacity. Dr. Myers, of Ft. Wayne.—Mr. President, just a word with reference to the medical colleges of Ft. Wayne. We have two there, and the rivalry between them is something like the rivalry between London and Edinburg; but there has been no exclusion whatever there. Our college has always admitted ladies, and we have suffered no inconvenience from their presence. I think they have had a salutary influence upon the gentlemen they met there. In conclusion, Mr. President, permit me to add: Let no man who has basked in the vitalizing sunshine of a mother’s countenance declare that the acute perception and warm, sympathizing heart of woman unfits her to minister at the bedside of suffering humanity. Dr. Boyd, of Dublin.— Mr. President, I want to take this opportunity to endorse for the hundredth time my standing on this question. I am satisfied that so far from being a disad vantage to a medical college to have mixed classes, it would be an advantage decidedly. We have had ladies in the convention here since we met, and the ladies have behaved themselves, as they always do, and we have behaved a great deal better than we would have done if they had not been here; and so I think it would be with students in college. Mrs. Dr. Thomas, of Richmond.— Mr. President, I want to say that I am very glad to hear the opinions that have been R131 A1 15 V5 N03 014 MEDICAL EDUCATION OF WOMEN expressed here with regard to this movement; and I want to say also that notwithstanding the gentlemen think they were controlled by financial considerations, that I believe the public sentiment of Indiana to-day is just that far along that a regular medical college, established at Indianapolis, with its doors open to all women competent to study medicine as well as men, throwing itself upon the manhood of the profession, would succeed. 15 R131 A1 15 V5 N03 015 Indianapolis, IN 46202 Indianapolis, IN Indianapolis, Org. Nonprofit Postage U.S. 46202 IN Indianapolis, Quarterly History Medical Indiana Society Historical Indiana 1 etOi Sre PAID Street Ohio West 315 ft) I 0z CO 0100 R131 A1 15 V5 N03 016 INDIANA MEDICAL HISTORY QUARTERLY CAlcreose In the treatment of all forms of bronchitis, especially the bronchitis associated with pulmonary tuberculosis, and the pulmonary complications of IN FLUENZA Calcreose has given good results. As high as 160 grains of Calcreose (80 grains af creosote) have been taken daily without causing any gastric distress or other discomfort which may fol low the administration of creosote. The dosage is accurate and easily controlled. INFLUENZA WARNING! Let’s be prepared! At the first indication of return of the influenza epidemic resort immediately to a PROVEN LINE OF DEFENSE. Meet the enemy at the port of entry, render ing the upper air passages hostile to his development and you’ve won the battle. DICHLORAMINE-T-CHLORCOSANE, Abblt; has proven its ability to protect against infectious diseases originating in the upper air tract, such diseases as meningitis, diphtheria, and influenza. TO PREVENT INFLUENZA (1) Spray the nose and throat twice daily with a 2% solution DICHLORAMINE-T la CHLORCOSANE, Abbott (2) Use CHLORAZENE, Abbott, 0.25% solution as a gargle every two hours. DICHLORAHINE-T, Abbott-powder in one ounce and four ounce bottles. CHLORCOSANE Abbott-in four ounce and sixteen ounce bottles. CHLORAZENE, Abbott-tablets of 4.6 gr. each. Bottles of 100, 500 and 1000. Write for literature to THE ABBOTT LABORATORIES, I o k Office u l Laboratories, Dept. 33, Chkl(o, IU. I NewYork Seattle San Francisco Loo Angolas Toronto Bombay INDIANA HISTORICAL SOCIETY Volume V Number 4 December, 1979 R131 A1 15 V5 N 0 4 001 Cover: The advertisement is from the 1919 issue of the Journal o f the Indiana State Medical Association. It shows the effect o f the 1918 influenza epidemic on patent medicines. The Indiana Medical History Quarterly is published by the Medical History Section of the Indiana Historical Society, 315 West Ohio Street, Indiana polis, Indiana 46202. MEDICAL HISTORY SECTION COMMITTEE CHARLES A. BONS ETT, M.D. Chairman and Editor 6133 East 54th Place Indianapolis, Indiana 46226 JOHN U. KEATING, M.D. 8415 Washington Blvd. Indianapolis, Indiana 46240 KENNETH G. KOHLSTAEDT, M.D. 645 East 80th Street Indianapolis, Indiana 46240 BERNARD ROSENAK, M.D. 5 254 North Delaware Street Indianapolis, Indiana 46220 DWIGHT SCHUSTER, M.D. 4503 Washington Blvd. Indianapolis, Indiana 46205 WILLIAM M. SHOLTY, M.D. 1831 Lilly Road Lafayette, Indiana 47905 W. D. SNIVELY, JR., M.D. R.R. 1, Box 277 Evansville, Indiana 47712 MRS. DONALD J. WHITE 3524 North Meridian Street Indianapolis, Indiana 46208 The Committee invites the contribution of manuscript material relating to the practice of medicine in Indiana — letters from or to physicians, diaries, case books, etc. Identified pictures of 19th century Hoosier doctors or medical meetings are also being sought. Objects relating to medical practice are desired for the Museum. Please write to Dr. Charles A. Bonsett, Chairman, Medical History Section, Indiana Historical Society, 140 North Senate Avenue, Indianapolis 46204. R131 A1 15 V5 N04 002 IN THIS ISSUE This issue o f the Quarterly is a presentation o f material by medical students, past and present. The principal feature is an article about the 1918 influenza epi demic in Indianapolis by Kathryn Hutchens of New Albany, Indiana. Currently a member o f the junior class at Indiana University School o f Medicine, Miss Hutchens completed this paper during her pre-medical years on the Bloomington campus while studying the history o f medicine in a class presented by Professor Frederick Church ill. This issue is completed with student material from an earlier period, spe cifically, 1904. In 1904 the Central College of Physicians and Surgeons (Indi anapolis) published its first (and, presumably, last) Annual. This was named the Placebo and was published by the senior class. The Central College of Physicians and Surgeons united with the Medical College of Indiana and the Fort Wayne College of Medicine to form a state-owned medical school, first with Purdue (1906) and later with Indiana University (1908). Presented here is an example o f student prose from that 1904 Placebo. The author is unknown except that he was a member o f the senior class. What is particu larly interesting is that he is writing from the 1904 perspective—a time o f horse- and-buggies and streetcars—a time when Marion County probably had fewer than twenty-five automobiles, and the morning newspaper had not yet had more than two small items about the aeroplane. He writes about the future, about his class mates and the year 1951. Influenza in 1918 was no longer thought to be due to the influence of the stars, but it did fit the traditional meaning of an epidemic, “ upon the people.” Modern statistical descriptions, even to the global tallies of 20 million deaths that year, fail to capture the numbing, sudden blanket of illness that fell over the world. The panic and hatreds that cholera could evoke just 60 years before were not part of the picture o f this latest scourge. There was nowhere to run, no filthy miasms responsible, no immigrant to blame. Now 60 years later the triumphs o f scientific medicine so desperately sought in 1918 allow us a comfortable assurance that influenza viruses can be made into cheap, easily-dispensed vaccines. Antibiotics can further lessen the deaths from secondary bacterial pneumonias. But in the last decade the evidence o f influenza in migratory birds, and the certainty that human and animal influenzas can recombine to produce ever new, unfamiliar strains o f the disease, have also pointed to the continuing vulnerability o f human populations. New vaccines to meet a mutant strain could not be produced quickly enough to interrupt the spread o f disease. The efficiency of public health teams—local, state, national and international—is impressive compared with that o f 1918, but rapid global transport and the vast numbers of people who could be stricken at once could make those teams inadequate to the task. Thus the study o f our reactions and responses to this kind o f crisis has a certain immediacy. Hutchens’ paper, based on the newspaper and public health officials’ accounts o f influenza in Indianapolis, not only illustrates how rich such sources can be in reconstructing public reactions to epidemic disease, but it raises many other interest ing issues. Were people more likely to listen to public health officers because it was a time o f war? Why were some citizens reluctant to admit the extent of disease in Indianapolis? What controls can any government be allowed over the individual during such epidemic crises? Do physicians and nurses have the same individual rights as other citizens? Does an individual have the right to refuse vaccination? Hutchens provides insights into some crucial decisions in Indiana medicine and health care delivery. R131 A1 15 V5 N04 003 4 INDIANA MEDICAL HISTORY QUARTERLY THE INDIANAPOLIS INFLUENZA EPIDEMIC OF 1918 Kathryn S. Hutchens In the early summer o f 1918, news reached the United States o f a new disease, known as the Spanish flu, which struck quickly and violently across Europe in its first wave by midsummer. Toward the end of September, a second wave o f the infection swept westward across the ocean to America and spread over practically the entire civilized world.1 On September 13, Surgeon General Rupert Blue issued a circular to medical officers at national quarantine stations ordering the inspection of vessels from European ports to detect flu cases, authorizing the detention of these ships and notification of local authorities. Fumigation with sulfur dioxide was recommended to combat the disease, which Blue considered “ highly cummunicable and suggestive o f epidemic influenza.” 2 The U.S. Navy prepared a report detailing the characteristic symptoms, in cluding sudden onset, sharp rise in temperature, and acute congestion often leading to bronchitis. After three to four days the patient usually recovers rapidly, but may instead develop a serious bronchopneumonia, the usual cause o f death. Influenza bacilli may be detected in the blood or swabs from the pharynx, but often only pneumococcus and pneumobacillus are found. The Navy report attempted to explain this puzzling lack of a specific bacillus by suggesting that the pneumobacilli were actually aberrant forms o f the “ polymorphic” influenza bacillus.3 In 1892, a bacillus had been isolated by Pfeiffer, a German bacteriologist, and it was assumed in 1918 that this organism was the real cause of influenza. This theory has since been disproved, and the infectious agent is known to be a filtrable virus. Even in 1918, the influenza bacillus had been found in whooping cough, measles, scarlet fever, and tuberculosis victims.4 In September o f 1918, Dr. J. J. Keegan observed that this bacillus grew much more dramatically and persisted longer in the presence of other germs. He predicted that influenza would spread over the entire country, affecting 30-40% o f the population, especially the younger, low- immunity groups.5 Dr. G. R. Lacy, in four case studies o f influenzal meningitis, positively identified the Pfeiffer bacillus but believed there were two types: one kind Was responsible for most influenza, while the other “ filamentous” form led to the complications associated with influenza.6 Research scientists and physicians o f 1918 were greatly handicapped because they could not then culture the virus or carry it through an animal host for controlled study.7 Techniques to study antibodies in the blood o f recently-recovered victims to develop an immunity serum for the specific, yet unidentifiable disease agent, were begun in 1918 but were purely experimental.8 American physicians facing the autumn epidemic in 1918 were advised that the sources o f bacterial infections were the secretions from the mouth, nose, throat, and lungs o f those individuals who were infected or carried the disease, and the mode of transmission was direct or indirect conveyance of secretions by droplet infection. Due to the wide distribution of well-carriers and undiagnosed cases, isolation and quarantine were considered inefficient in controlling influenza’s spread. Recom mended treatment included immediate bed rest, warmth, fresh air, nutritious food, Dover’s powder for pain, and quinine or aspirin for fever.9 Throughout the period of influenza’s approach, the Navy urged attending physicians to wear gauze masks and to advise and educate the public to avoid crowds and “ promiscuous coughing and spitting.” 10 These general recommendations were critical to American physicians R131 A1 15 V5 N04 004 INFLUENZA EPIDEMIC OF 1918 5 and public health officials in their treatment and understanding of the 1918 influ enza epidemic. On September 12, 1918, the U.S. Public Health Service reported an outbreak o f influenza in Boston, Massachusetts, involving over 1400 confirmed cases since August 28. The infection was severe, resulting in pneumonia in more than 10% of all cases, and a high mortality rate.11 By September 17, over 2500 cases were known in Boston, and an alarming outbreak had begun at Camp Lee, in Petersburg, Virginia.12 In preparation for the epidemic’s arrival in Indiana, Dr. John N. Hurty, secre tary o f the Indiana State Board of Health, ordered a statewide survey on September 19 to determine the prevalence o f autumn influenza. The Indianapolis News report ed that Hurty recognized the impracticality o f quarantine, and urged that the best therapy was to “ Keep your body in a splendid condition and let it do its own fighting” against infections.13 On September 25, the News expressed the hope that better weather might help check influenza in Indianapolis, since the disease was thought to spread more rapidly in unseasonable weather.14 But on the next day, influenza was confirmed in at least 13 Indiana communities.15 In contrast to the frank, straightforward approach o f the News at the advent of Spanish flu, the city’s other major newspaper, the Indianapolis Star, adopted a much more positive, optimistic attitude. The Star emphasized often that the public should not fear the disease, although influenza was already epidemic in several Eastern states, but should cooperate fully in enforcing the preventive measures o f the medical authorities to forestall an Indianapolis epidemic. On September 27, the Star reported, despite 20-25 suspected civilian cases, that the disease was restricted thus far to nearby military camps, including Fort Benjamin Harrison, and a Beech Grove construction company. Dr. Herman Morgan, secretary o f the Indianapolis Board o f Health, stated that the city, with the “ proper vigilance,” might escape a serious epidemic. Mayor Charles Jewett directed the chief o f police to begin vigorous enforcement o f an anti-spitting ordinance, as urged by the Board o f Health.16 Dr. Hurty agreed that “ the public spitter is a nuisance and must be treated as such,” also warning that if an “ epidemic,” defined as a prevalence of 10 cases per 1,000 people, should occur in an Indiana community, all schools, picture shows, revivals, and public gatherings would be suspended. Epidemic influenza had occurred in certain army camps in the state.17 The Surgeon General now required telegraphic reports of cases from each state to the Public Health Service, indicating that the disease had already reached national scope in just a few weeks.18 Dr. Morgan met with city theater managers, seeking their cooperation in prevention, and ordered daily cleaning and fumigation o f streetcars. According to Dr. Hurty, Indiana’s autumn influenza was no worse than in previous years, but the Red Cross o f Indianapolis prepared to mobilize immediately for duty in the case of a city epidemic, obtaining a large building as a temporary hospital.19 Since Wash ington had called for 50,000 new army and navy nurses, the trained nurse could no longer serve civilians. The Star urged women to enroll in Red Cross classes for ele mentary hygiene and home care o f the sick.20 In this epidemic, good nursing care was often considered more important, and perhaps more difficult to secure, than “ good doctoring,” since therapy in the absence of a specific treatment was neces sarily symptomatic.21 The Star also reported work on a vaccine, an “ almost positive preventative o f contraction o f pneumonia,” to be used against complications of Spanish flu, which was present in every state. In addition to these measures, Con gress, in a unanimous resolution, appropriated $1 million for use by the Public Health Service to fight domestic communicable disease.2 2 This action, representing R131 A1 15 V5 N04 005 6 INDIANA MEDICAL HISTORY QUARTERLY quite a drastic measure in the tightly controlled wartime economy o f 1918, reflects the great public concern on the eve o f a national epidemic. The first four civilian cases attributed to epidemic flu were reported in Indi anapolis on September 30, prompting an order from the Board o f Health prohibiting those with coughs, colds, or sneezes from entering movie theaters.2 3 This measure was much more restrictive to the wartime society of 1918, in the absence of tele vision and other entertainments, than it would seem to contemporary Americans. In 1918, attending a movie theater was perhaps the most important available social ac tivity, proven by the large number o f theaters and the great degree of their adver tising in Indianapolis papers. Dr. Morgan, expressing a “ wait and see” attitude in the hope that stricter measures would not become necessary, appealed to every citizen to adopt the role o f a health officer in preventing disease. The Star attempted to soothe public fears by presenting statistics demonstrating a regular increase in Indiana flu deaths from 3 per month in summer to a peak of 144 in February. How ever, the usual victims were babies and the elderly, while in 1918, “ persons in the vigor of youth and middle age” were victims.24 The American Medical Association claimed that older persons were less susceptible because, having lived through the last flu epidemic 28 years before, they had acquired a general immunity to virulent epidemic virus.25 Despite this reluctant observation, the Indianapolis Star stressed that the disease was not yet beyond control in the city. By October 2, the 200 reported cases and 4 deaths among city civilians prompt ed the city health board to impose a ban on public gatherings as a preventive meas ure. The superintendent of city schools and the secretary of the church feder ation, as well as the Theater and Moving Picture Associations, were notified of the citywide closing order. Dr. Morgan justified the ban, pointing out that influenza was transmitted in crowds, and school children and others could easily carry the disease, although they were not afflicted.26 Thus flu necessitated the first school closure since a 1910 diptheria epidemic, and for the same reason—the recognition of a large group of well-carriers. On October 8, the Star presented its first front-page influenza article under the headline “ Influenza Epidemic Here Well In Hand,” despite its first admission that flu had reached epidemic proportions in the city, and was no longer localized in nearby camps.27 A closing order was imposed by the state board of health prohibiting all public meetings and requiring daily physicians’ reports and ventilation of railroad cars and streetcars.28 The state board had assumed great authority in enforcing an unprecedented statewide closing order, but local health officers interpreted whether gatherings at poolrooms, bowling alleys, “ dry beer” saloons, and clubs should be considered “ public,” and hence prohibited. Court sessions were allowed to proceed, without spectators, and all soda fountains, restaurants, and eating places were ordered to sterilize all utensils. Even the campaign speeches of both parties were abruptly cancelled by the ban, forcing a much greater reliance on political literature, signs, and billboards.29 Since all theatrical, and many business, advertisements had been curtailed, a wealth of political announcements replaced these in Indianapolis papers. Dr. Morgan praised public and commercial cooperation in adhering to the health orders, and suggested that firms employing many workers could improve ventilation by giving employees the opportunity o f “ taking fresh air at an open window or out of doors at least four times each day.” 30 Clearly, public health officers had achieved quite powerful control over business and social organization in the city, including commerical concerns, public transportation systems, schools, and churches, through these sweeping regulations. The 1918 flu epidemic brought a R131 A1 15 V5 N04 006 INFLUENZA EPIDEMIC OF 1918 7 change in public attitude toward health authorities: the public, perhaps conditioned by the necessities o f wartime regulation, freely accepted and obeyed health officials with confidence.31 Indiana governor James P. Goodrich announced that 100 nurses had been recruited to assist in critical training camps, where commander Major Crawfis as sured him that the epidemic was now controlled, although Dr. Morgan reported a definite increase in city pneumonia deaths.3 2 As the disease toll continued to rise, the Indianapolis board o f health ordered all stores, except drug and food stores, to observe strict 9:45 to 6:15 open hours. Furthermore, Dr. Morgan recommended that postal workers should wear gauze masks to prevent spreading influenza.33 On the state level, Dr. Hurty recognized that stock and farm sales were a “ war necessity and part of the essential industry o f the country in the prosecution o f the war.” 34 Accordingly, board of health regulations were always modified in the interest o f the war effort. By October 14, Dr. Hurty hoped that the state peak was near and expected the epidemic to disappear quickly thereafter. Hence, perhaps prematurely, he abandoned plans to establish an “ Influenza Commission” o f state and city commercial, pro fessional, and social organizations. Dr. Morgan, experiencing the angry reaction of “ dry beer” saloon owners, who resented the early closing ban, warned outright that such shops would be closed entirely unless loitering were prohibited, as ordered. At his advice, Mayor Jewett ordered six companies o f the fire department to flush the streets and sidewalks o f downtown Indianapolis to prevent germ spreading.35 In this crisis, the broad powers of public health officers extended even to the activities o f other civil authorities, including both the police and fire departments. In a September address, Dr. Joseph Eastman, president o f the Indiana State Medical Association, praised the patriotism o f Indiana physicians. Nearly 50% of all Indiana male doctors under 55 years o f age and not physically defective had applied for commissions in the Medical Reserve Corps.36 “ Before long,” Dr. Eastman warned, “ anyone requiring the services o f a doctor will be obliged to enter the army to get a good one.”37 The October 15 Journal o f the Indiana State Medical Associ ation first mentioned the need for strict rules to suppress influenza. Physicians, recognizing the war-imposed deficit in their own numbers, insisted that the board o f health be given great power to regulate disease.38 The Indianapolis News reflect ed this statewide concern that many younger doctors had departed for war and “ the heavy strain on the older ones is beginning to tell.” 39 Meanwhile, the flu epi demic continued to spread in the city. Dr. Charles Emerson, dean o f the Indiana University Medical School, reported that Indiana should keep all doctors in the state to fight disease, since the worst danger was yet to come after the peak of influenza cases.4 0 In almost every death, pneumonia was recognized by Dr. Morgan as the true cause, with influenza as the contributing cause.41 Assistant Surgeon General Allan McLaughlin advised the public, “ Do not give whiskey to persons during the early stages of the disease. Hold o ff on whiskey so it may be used to bolster the heart in case pneumonia develops.” 42 Doctors felt that the heart muscles or nerves were weakened in severe pneumonia, and could be strengthened by whiskey. Bacteriologists o f 1918 often found the rod-shaped Pfeiffer’s bacillus, but in other cases, germs of lobar pneumonia, streptococci, and “ other germs with long names” were found.43 Physicians suffered the handicap of an unidentifiable disease agent throughout this epidemic. This poor understanding of the nature o f the flu virus was central to many public health measures attempting to control the disease, such as mandatory cleaning and fumigation o f school buildings and vehicles, strict ventilation laws, and the theory that favorable weather might im prove the situation in Indianapolis.4 4 R131 A1 15 V5 N04 007 8 INDIANA MEDICAL HISTORY QUARTERLY Dr. William King of the U.S. Public Health Service stressed that the epidemic must run its course, usually for three weeks, before it could again become endemic, despite all regulations. Influenza now swept the state from north to south,4 5 forcing the extension of the public gathering ban, although the northern counties were expected to be released early.46 The two state political committees were again forced to cancel campaign openings, with only two weeks before the election. Noting this, the Star wryly observed that at least “ it is not likely that there will be much spellbinding in Indiana this year.” 47 Perhaps the political effects were not as serious as it may seem, for the war and the flu menace overshadowed the campaigns, creating a general lack of public interest. Political notices near election day did not intensify. Indeed, throughout this time, the most prevalent advertisements were the ubiquitous Liberty Bond appeals, victrola sales, radios, books, and influenza reme dies; the latter including “ Dr. Bell’s Pine Tar Honey,” “ Snake Oil,” and “ Father John’s Cure.” Despite the record 3,275 cases reported on October 18, estimated by Dr. King as only 25% of true cases,48 by October 20, the Star was proclaiming a hopeful out look for Indianapolis. But on the same page, the Star rather incongruously ran a story appealing for volunteers to staff three Richmond, Indiana, casket plants rushed by government orders for influenza’s victims.4 9 As the city toll rose to 212 deaths, Dr. King re-emphasized the critical need for nurses, securing a promise from the Surgeon General o f an Indiana Red Cross official to train more nurses.5 0 The state board insisted that all private case nurses be released, and that physicians postpone non-emergency surgery due to the short age o f nurses. Dr. Hurty reported a great improvement in the north, no change in the central area, and rapid spread o f flu in the south o f Indiana.51 However, his opti mism on the northern condition seemed premature in following days, as it became clear that pneumonia deaths were actually increasing in these counties. A dreaded “ second crisis” swept northern Indiana,52 and officials learned that the disease tended to occur in waves.53 Over 180 new cases in the state convinced Dr. Morgan that the Indianapolis crest had not yet been reached, resulting in an extension of the closing ban to November 2.54 The state board decided that counties where influenza had not been epidemic for at least five days could appeal for modification of public health regulations.55 On October 24, the News recognized that the change in weather had no favor able effect on disease, as hoped. “ While the heavier atmosphere may prevent the scattering o f germs. . .influenza is a disease o f the house and the crowd, and weather that keeps persons indoors without proper ventilation may result in an increase in the number of cases.” 56 Anxious to prevent droplet infection, Dr. Hurty warned the public against trying on Halloween masks in 1918. Dr. Morgan restated his faith in isolated bed rest at home, pointing to the danger of cross-infection in crowded hos pitals.57 Although he stated that “ innoculations of bacterins” might prove a valu able measure, the national health organization stressed that all vaccines were purely experimental in this epidemic.58 October 25 was a bleak day in Indiana, witnessing 2,083 new cases, a new record for one day. No county was able to modify the state ban. Dr. King remarked that the epidemic was “ by far the most dreadful calamity that has ever befallen the state of Indiana.” 59 In the week ending the 19th of October, 16,170 cases were reported in the state, excluding Indianapolis, which reported 1,881 new cases.60 On October 28, as Gary permitted reopening o f schools, the state board o f health considered requiring that masks be worn at all public gatherings as the ban was first lifted.61 Halloween parties and gatherings were prohibited in Indianapolis under the R131 A1 15 V5 N04 008 INFLUENZA EPIDEMIC OF 1918 9 ban.6 2 This alone was credited with saving the city from a more drastic epidemic that year.6 3 Dr. Morgan proposed lifting the city ban on October 31 due to the continued recession o f new cases.6 4 The jubilant Star announced that “ the city once more is free from restraint and depression.” 65 The News proclaimed that, after three weeks o f regulation, Indianapolis stores would reopen at usual hours, theaters would reopen, and schools, social and religious groups, and businesses could resume normal activities. However, those with colds or coughs were not admitted to theaters, street cars maintained open windows, and Halloween celebrations downtown were ex pressly forbidden. City officials again commended the public on their observance of health measures.6 5 Dr. Morgan was satisfied that the virulence o f the influenza and pneumonia organisms was waning as the Indianapolis death rate fell.6 6 The News stated that there had been 6,031 cases and 339 deaths in the city since September 26, and 53,224 cases and 1,336 deaths in the rest o f the state.67 The Public Health Service reported a nationwide occurrence of 86,045 deaths up to October 26, warning that early statistics were very incomplete.6 8 By November 2, the national total exceeded 115,000 deaths.69 Although the national situation still appeared critical, in Indianapolis the ban lifting was heralded by a great flourish o f wedding announcements, party notices, and theater advertisements in the city newspapers. The Star immediately shifted its focus away from the flu and downplayed its importance by printing only a small back-page article on the southern Indiana epidemic.7 0 In a city weary o f both war and disease, the newspaper relieved a part o f the psychological stress on the public by devoting itself to covering the end o f World War I and dismissing the lingering tragedy o f a domestic epidemic. Also, the general elections o f November 6 began to receive long-overdue attention from the city press. An epidemic of “peace fever” seemed to replace worry over influenza. A critical feature in the course o f the 1918 epidemic across America is typified by the November 11, 1918, double extra edition o f the Indianapolis Star, which proclaimed the news that “ Germany Surrenders!” as “ the happiest day o f the world’s life.” 71 A sharp upturn in the incidence o f flu occurred immediately after this joyful period, largely due to the “ almost universal exchange o f saliva” that must have occurred on that occasion.72 By November 16, a persistent increase in Indi anapolis flu cases was noted, involving 181 new cases on this day.73 The city health board then ordered that masks be worn in all public places, re-closed schools and libraries, and discouraged public gatherings, although stores were not closed. Dr. Morgan attributed the recurrence throughout the state directly to peace celebrations, including two in Indianapolis. He noted that the new outbreak seemed changed, since it affected children to a greater extent, and also seemed milder than before.74 A November 20th full-page announcement by twelve city theaters underscored their desire to remain open and their eagerness to comply with the powerful board’s regulations. This advertisement reads: You can safely attend the following theaters. They are properly ventilated and constantly maintained in perfect sanitary condition. Remember that clean, wholesome amusement is the world’s most efficient antidote for all ills—Try the Laugh Cure! Masks must be worn on entering the theater and continuously during the performance by Order o f the Board o f Public Health.7 5 On November 22, Dr. King admitted that there was little hope of checking influenza in the state until all susceptible people had experienced the disease, and R131 A1 15 V5 N04 009 10 INDIANA MEDICAL HISTORY QUARTERLY that prevention o f secondary pneumonia was the only useful aspect of treatment.7 6 The Indiana State Medical Association bitterly recognized that . . .in the future we will look back on this epidemic of influenza and pneu monia with wonder and surprise. In spite o f our vaunted advancement in medicine we have utterly failed in the present crisis. The epidemic is going to continue until every susceptible person has been infected, just as if there were no physicians.7 7 These physicians attributed the failure o f their profession to an ignorance of pre ventative medicine.78 Although it was doubtful whether the available medical treatment was of great value, it is certain that the advice o f doctors was indeed often invaluable since it was pointed at avoidance o f the secondary infections which were most dangerous.7 9 In this respect, Indiana physicians perhaps underestimated their own positive effect during the epidemic o f 1918. Dr. King urged a major re-organi- zation o f public health in Indiana to replace part-time officials in private practice with full-time public servants. He insisted that “ it is the system that is wrong,” pre venting local officers from enforcing health measures, not necessarily ignorance of correct procedure or a failure o f the medical profession.7 9 The Indiana State Medical Association (ISMA) agreed that “ the experience in the influenza epidemic points more clearly to the value of an all-time health officer.” 80 Influenza again began declining in Indianapolis, although public officials were ridiculed for requiring that gauze masks be worn. This measure was perhaps the target of greatest public resistance. Dr. Thurman Rice, an assistant to Dr. Hurty, recalled that people failed to understand that the infectious agent was always found in particles of saliva, or that a mask would protect one person from the germs spread by others, although officials realized that masks could not entirely control the infection.81 By early December, influenza had again died down in Indiana.8 2 It seems that the lessons learned in the 1918 epidemic were being applied to develop better treatments. The Journal of the ISMA reported that bacillus influ enzae had never been the sole invading organism. Vaccines were being developed against the virulent pneumococcus in hopes o f lower mortality rates in future out breaks.83 The Journal criticized the public, “ ever ready to be humbugged,” for relying upon proprietary medicines or quack doctors to cure influenza, as well as the Indiana papers for allowing such deception and swindling, “ for without adver tising the medical frauds would cease to exist.” 84 The U.S. Public Health Service had earlier advised the public against “ sure cures” for flu, including specific reme dies, “ pseudoscientific treatment” (such as “ isotonic sea water,” “ ozono therapy,” and “ harmonic vibrations,” ) superstitious ritual (such as sprinkling sulphur in one’s shoes each morning), food fads, and camphor amulets, all of which were considered of no use.8 5 In the absence o f a medical treatment, many o f these methods had be come popular. On February 7, 1919, the Public Health Service released a table o f mortality rates during a 15-week period in Indianapolis, reporting 969 deaths in the popu lation o f 289,577. The week ending October 19 had been the peak o f the epidemic mortality, bringing 128 deaths to the city. Much later, in 1930, the statistics from the epidemic were again analyzed, indicating that excess mortality in Indianapolis increased from 38.4 per 100,000 in the spring of 1918 to 392.8 in the winter of 1918-19, then dropped to 118.2 in a 1920 flu recurrence, and finally to 29.6 in 1922.86 In terms o f death rate per 100,000, the excess during the influenza period climbed from 14 in August, 1918, to 64 in September, to 1,381 in October, when R131 A1 15 V5 N04 010 INFLUENZA EPIDEMIC OF 1918 11 the disease was at its peak, then dropped to 1,046 in November, 767 in December, 319 in January, 338 in February, 623 in the March recurrence, 156 in April, and finally dropped to 5 in May o f 1919.8 7 These statistics prove the extent and severi ty o f the 1918 flu epidemic and are invaluable in understanding this period o f public fear and uncertainty. During the 1918-1919 flu epidemic, many scientific studies were undertaken of the disease, which proved that general sanitary conditions, individual susceptibility, and weather conditions had very little effect on occurrence.8 8 However, crowding and droplet infection were proven important in spreading the disease.89 Only much later could the real cause o f disease be understood, the variation in the virulence of a living germ, responsible for the epidemic’s spread.90 C.E.A. Winslow selects 1920 as the close o f the Bacteriological Era, attributed to the failure o f science to solve the riddle o f the great influenza epidemic o f 1918- 1920. New methods were necessary to allow recognition and cultivation o f the filtrable viruses.91 An excess o f 300,000 deaths occurred in the continental United States during the pandemic, causing a devastating emotional impact upon American society.9 2 The attrition in America due to influenza was at least ten times that suffered by Americans in the four long years of World War I.9 3 Worldwide, about 15-20% of the population was afflicted, resulting in nearly 20 million estimated deaths, almost a 1% world mortality rate, the highest ever known.94 It should not then be surprising to modern citizens that public health officials, in Indianapolis and across the entire country, assumed such vast authority when the dreaded influenza epidemic occurred, or that a single mysterious disease promoted such widespread fear among the general public and inspired such a great wealth o f research among physicians and bacteriologists. Today, as a result o f the foresight and dedication o f those who fought the 1918 flu epidemic and o f the knowledge and understanding which they sought, modern Americans, once again fearful on the eve of a threatened outbreak o f a strain o f influenza, have inherited a tradition o f successful research and public health organization which has established a precedent for the productive scientific prevention and treatment o f influenza. NOTES Thurman B. Rice, The Hoosier Health Officer, A Biography o f Dr. John N. Hurty, in Bulle tin o f the Indiana State Board o f Health (Indianapolis, 1946), p. 282. United States Public Health Service, Public Health Reports, (1918), Vol. 33 No. 37. p. 1540. 3 Ibid. p. 1542. 4 Journal o f the American Medical Association, Vol. 71, No. 14, p. 1137. 5 J.J. Keegan, “ The Prevailing Pandemic of Influenza,” in Journal o f the American Medical Association, Vol. 71, No. 13. (Sept. 28, 1918), pp. 1051-55. G.R. Lacy, “ The Bacillus Influenza in Sinusitis and Meningitis,” in Journal o f Laboratory and Clinical Medicine, Vol. 4, No. 2. (Nov. 1918), pp.55-59. 7 Rice, pp. 282. 8 Journal o f the American Medical Association, Vol. 71, No. 14 (1918), p. 1137. 9 Public Health Reports, Vol. 33, No. 37 (1918), p. 1543 10 Ibid, p. 1544. 11 Ibid, p. 1554. 12 Ibid, p. No. 38, Sept. 20, 1918, p. 1604. 13 Indianapolis News, Sept. 20, 1918. 14 Ibid, Sept. 25, 1918. 15 Ibid, Sept. 26, 1918. 16 Indianapolis Star, Sept. 28, 1918. 17 Indianapolis News, Sept. 27, 1918. 18 Public Health Reports, Vol. 33, No. 39, Sept. 27, 1918, p. 1625. R131 A1 15 V5 N04 011 12 INDIANA MEDICAL HISTORY QUARTERLY 19 Indianapolis News, Sept. 30, 1918. 20 Indianapolis Star, Sept. 29, 1918. 21 Bernard Fantus, “ Clinical Observations on Influenza,” in Journal o f the American Medical Association, Vol. 71, No. 21. (Nov. 23, 1918), pp. 1736-39. 22 Indianapolis Star, Sept. 30, 1918. 23 Indianapolis News, Oct. 1, 1918. 24 Indianapolis Star, Oct. 2, 1918. 25 Journal o f the American Medical Association, Vol. 71, No. 14, p. 1136. 26 Indianapolis Star, Oct. 7, 1918. 27 Ibid, Oct. 8, 1918. 28 Indianapolis News, Oct. 9, 1918. 29 Indianapolis Star, Oct. 10, 1918. 30 Ibid, Oct. 8, 1918. 31 Journal o f the American Medical Association, Vol. 71, No. 15, Oct. 12, 1918, p. 1223. 32 Indianapolis Star, Oct. 9, 1918. 33 Indianapolis News, Oct. 12, 1918. 34 Indianapolis Star, Oct. 12, 1918. 35 Indianapolis News, Oct. 14, 1918. 36 Journal o f the Indiana State Medical Association, Vol. XI, No. 10, Oct. 15, 1918, p. 359. 37 Ibid, pp. 359-60. 38 Ibid, p. 374. 39 Indianapolis News, Oct. 16, 1918. 40 Ibid. 41 Ibid, Oct. 15, 1918. 42 Indianapolis Star, Oct. 18, 1918. 43 Ibid. 44 Indianapolis News, Oct. 17, 1918. 45 Ibid. 46 Ibid, Oct. 18, 1918. 47 Indianapolis Star, Oct. 17, 1918. 48 Indianapolis News, Oct. 19, 1918. 49 Indianapolis Star, Oct. 20, 1918. 50 Indianapolis News, Oct. 21, 1918. 51 Indianapolis Star, Oct. 22, 1918. 52 Indianapolis News, Oct. 23, 1918. 53 Indianapolis Star, Oct. 23, 1918. 54 Ibid, Oct. 25, 1918. 55 Ibid, Oct. 26, 1918. 56 Indianapolis News, Oct. 24, 1918. 57 Ibid. 58 Ibid, Oct. 25, 1918. 59 Ibid, Oct. 26, 1918. 60 Public Health Reports, Vol. 33, No. 44, Nov. 1, 1918, p. 1861. 61 Indianapolis News, Oct. 28, 1918. 62 Ibid, Oct. 29, 1918. 63 Indianapolis Star, Oct. 29, 1918. 64 Ibid, Oct. 30, 1918. 65 Indianapolis News, Oct. 30, 1918. 66 Indianapolis Star, Oct. 31, 1918. 67 Indianapolis News, Oct. 31, 1918. 68 Public Health Reports, Vol. 33, No. 44, Nov. 1, 1918, p. 1859. 69 Ibid, No. 45, Nov. 8, 1918, p. 1913. 70 Indianapolis Star, Nov. 3, 1918. 71 Ibid, Nov. 11, 1918. 72 Rice, Hoosier Health Officer, p. 282. 73 Indianapolis Star, Nov. 17, 1918. 74 Ibid, Nov. 19, 1918. 75 Ibid, Nov. 20, 1918. 76 Ibid, Nov. 22, 1918. 77 Journal o f the Indiana State Medical Association, Vol. XI, No. 11, Nov. 15, 1918, p. 409. 78 Ibid, p. 410. R131 A1 15 V5 N04 012 INFLUENZA EPIDEMIC OF 1918 13 79 Indianapolis Star, Nov. 22, 1918. 80 Journal o f the Indiana State Medical Association, Vol. XI, No. 11, p. 415. 81 Rice, Hoosier Health Officer, p. 282. 82 Ibid. 83 Journal o f the Indiana State Medical Association, Vol. XI, No. 12, pp. 447-48. 84 Ibid, 448. 85 Public Health Reports, Vol. 33, No. 45, Nov. 8, 1918, pp. 1932-33. 86 Ibid, Vol. 45, No. 39, Sept. 26, 1930, p. 2302. 87 Ibid, p. 2309. 88 Paul G. Wooley, “ The Epidemic of Influenza at Camp Devens, Massachusetts,” in Journal o f Laboratory and Clinical Medicine, Vol. 4, No. 5. (Feb. 1919), pp. 330-43. 89 Ibid, p. 339. q q C.E.A. Winslow, The Life o f Hermann M. Biggs (Philadelphia, 1919) p 49 91 Ibid, p. 75. 92 Ibid, p. 86. 93 Harry S. Wain, A History o f Preventative Medicine (Springfield, 111., 1970), p. 383. 94 Erwin H. Ackerknecht, History and Geography o f the Most Important Diseases (New York, 1965), p. 189. BIBLIOGRAPHY Ackerknecht, Erwin H., M.D., History and Geography of the Most Important Diseases, New York, Hafner Publishing Company, 1965. Cassady, James H., Charles V. Chapin and the Public Health Movement, Cambridge, Massachusetts, Harvard University Press, 1962. “ Causes of Geographical Variations in the Influenza Epidemic of 1918 in the Cities of the United States,” Bulletin o f the National Research Council, Volume 6, Part 3, Number 34, July, 1923. Fantus, Bernard, M.D., “ Clinical Observations on Influenza,” Journal o f the Ameri can Medical Association, Volume 71, Number 21, November 23, 1918, pp. 1736-9. Indianapolis News, daily newspaper for Indianapolis, Indiana, from September 20, 1918, to November 1, 1918. Indianapolis Star, daily newspaper for Indianapolis, Indiana, from September 27, 1918, to November 30, 1918. “ Influenza Report,” prepared by the Division o f Sanitation, Bureau of Medicine and Surgery, Department o f the Navy, Washington, D.C., August 9, 1918, published in Public Health Reports, Volume 33, Number 37, September 13, 1918. Journal o f the American Medical Association, Volume 71, Numbers 14, October 5, 1918; 15, October 12, 1918. Journal o f the Indiana State Medical Association, Volume XI, Numbers 10, October 15, 1918; 11, November 15, 1918; 12, December 15,1918. Keegan, J.J., M.D., “ The Prevailing Pandemic of Influenza,” Journal o f the Ameri can Medical Association, Volume 71, Number 13, September 28, 1918, pp. 1051-5. Lacy, G.R., M.D., “ The Bacillus Influenzae in Sinusitis and Meningitis,” Journal o f Laboratory and Clinical Medicine, Volume 4, Number 2, November, 1918, pp 55-9. La Fetra, Linnaous E., M.D., “ Some Clinical Manifestations of Influenza in Chil dren,” American Journal o f the Medical Sciences, Volume 157, June, 1919 pp. 770-5. Public Health Reports, issued weekly by the United States Public Health Service, Volumes 33, 1918; 34, 1919; 45, 1930. R131 A1 15 V5 N04 013 14 INDIANA MEDICAL HISTORY QUARTERLY Rice, Thurman B., M.D., The Hoosier Health Officer, A Biography o f Dr. John N. Hurty, published in the Bulletin o f the Indiana State Board o f Health, Indi anapolis, 1946. Wain, Harry S., M.D., A History of Preventative Medicine, Springfield, Illinois, Charles C. Thomas Publishers, 1970. Winslow, C.E.A., et al., The History of American Epidemiology, St. Louis, The C. V. Mosby Company, 1952. Winslow, C.E.A., The Life o f Hermann M. Biggs, Philadelphia, Lea and Fobiger, 1929. Wooley, Paul G., M.D., “ The Epidemic of Influenza at Camp Devens, Massachu setts,” Journal o f Laboratory and Clinical Medicine, Volume 4, Number 5, February, 1919, pp. 330-43. CLASS PROPHECY (With apologies to Edward Bellamy and others, especially the readers) It was on a summer evening in 1951 when Eber. D. McKinley, M.D., LL. D., ’04, of The Central College of Physicians and Surgeons, after a busy day in his famous and popular sanitarium, in Eberdale, a suburb of New York City, failing to find rest in his luxurious apartments, determined over his Cafe Noir and cigarettes to visit his Alma Mater, and, if possible, to ascertain the whereabouts and doings of the other members of that famous class. He rang for his valet and ordered him to have rigged his newest and speediest air-ship for a sail. Ten minutes sufficed to present it along-side the roof-garden, with search light aglow, and engines pulsating with restless energy. Stepping inside, the door was hermetically sealed and air containers opened. The “ aeronauteur” was directed to drive straight for Indianapolis. Thirty-eight minutes sufficed to bring that city in sight. They distinguished it from the other cities, which had been passed so rapidly beneath them, by the illumination of the avenues, which gave it from above the peculiar appearance o f a wheel having spokes of fire. Slowing down they noted near the city’s center an immense structure, upon whose roofs an immense biological garden and aquarium presented, and whose central dome displayed in letters of fire, the familiar symbol, Central College of Physicians and Surgeons. They dropped carefully to the anchoring deck on the ledge where a number of other machines were anchored, and alighting were directed by uniformed guides and attendants to the electric elevator, which dropped them to the twenty-second floor, which was given over to the Dean’s and his clerks’ offices. There, the once fat Ford was found at the post, delayed past the usual hours by extra work on the new curriculum which provides for a life-time course of thirteen months in the year. He was no longer stout, but tall, thin, stooped and gray, with an area at the vertex of the skull, some 6 by 8, boldly shining in the mellow light of the shaded radium illuminator which occupied an unobtrusive spot in the ceiling. Greeting exchanged, they fell to reminiscing. It was found that the old college building, from which they had so proudly graduated, was now insufficient in size to accommodate even the heating plant of the modern structure, so it had been tom down and the brick used to construct a chimney for the new heating plant, which reposed unobtrusively in the rear o f the college building. R131 Al 15 V5 N04 014 CLASS PROPHECY 15 When they fell to discussing the whereabouts of their old classmates, it was suggested that by Marconigram’s to the Bureau of Information of the American Medical Association, they might be able to trace most of them. So over cigarettes, to which McKinley was a devotee, and champagne which was to be found in an aseptic aluminum cooler in each room in the building, they listened to the reports read by the weary old Dean’s private “ marconographer.” Many were readily located, others hard to trace, while three were absolutely not to be found. First, Prof. P. G. Carlisle, still connected with the school; professor o f obstetrics and superintendent of the Maternity Hospital, maintained by the institution be tween 318th and 319th streets on North Illinois. He was still single, but a frequent participant in the doings of high society. Prof. A. Fisher, M. D., translator of recent books from the German and director o f physical culture; devoted much o f his time to demonstrations in the graceful art o f correct walking. The Professor was very fond o f this exercise, often taking long excursions unaccompanied. Dr. Moreland had long since retired, upon a handsome competency derived from the royalties upon the sale of an anti-toxin for “ Ennui,” of which he was the discoverer. J. Guy Hoover, M. D., having sometime in the year 1921 met his fate in the form of a wealthy, beautiful and accomplished young lady, renounced the hum drum life of surgeon, ceased the uninteresting work o f cutting o ff arms and legs, doing laparotomies, etc., and went in for society and to win. Having won, the butcher’s life no longer appealed to him, and from all we could learn “ society” still holds him a humble devotee at her throne. E. E, Robards, M. D., needed no strenous effort to be located, for soon after graduation he became the partner o f Dr. Fred. C. Valentine o f New York, and when that eminent specialist was gathered to his Father’s, Prof. Robards assumed the entire work. Dr. Marshall, soon took Shakespeare’s advice, “ to throw physic to the dogs,” and having accumulated a paltry ten millions in the instrument business, retired. America was too small for Heinrichs, so taking up pathology where Cohn- heim left off, he distinguished himself and his Alma Mater upon the continent of Europe, and with Prof. Medsker for a partner succeeded in making many important discoveries, one being the baccillus interrogosus and another closely resembling it, the baccillus butter-in-skyosis. Thus, oft do our own infirmities stimulate us to research, which bear fruit to all mankind, for we note in the International Journal o f Medicine, that they have elaborated an anti-toxine, which bravely and for the sake of science, they tried upon themselves with encourageing results, considering the chronicity of their infection. Don Ivey located in a small town in northern Indiana. The Dr.’s moustache and the town grew hand in hand, and now with Chicago as the town’s smallest suburb, and Dr. Ivey as its leading physician, his success is assured. Max Hawley was hard to hear from but was finally located in a retreat in northern Germany, re-editing Hektoen and Reisman, but owing to his retirement from the active life o f the profession, but little could be learned about him. A special messenger had been sent by the bureau, but he returned with the report that the only time he saw him in a ten day’s siege o f his castle was one day, when, for a moment, he stepped outside the door to “ borrow a match” from the gate keeper. It was noted that he still clutched a half burnt, but “ dead” cigarette, grimly in his teeth. R131 A1 15 V5 N04 015 16 INDIANA MEDICAL HISTORY QUARTERLY H. A. Reed, M. D., had become the medical director o f the International Oil Company, through the recommendation of his old friend, John D. Rockefeller. Barmm, Wier, Wheeler and Deem were reported to have formed a stock compa ny for the manufacture o f a “ hair oil” and “ corn cure,” and were making “ barrels of money.” Morris was city sanitarian to Brightwood and member of the faculty. Campbell, Dutton and Stoltzer were the three from which they could not hear. It was surmised from an article in the “ Y. M. C. A. Review,” headed “ Necrology,” (?) that Campbell and Dutton had been devoured by cannibals while acting as medical missionaries. Other reports had it that Campbell had migrated to Utah and joined the Mor mons, while Dutton took to histrionics and was doing heavies as a tragedian. The last that had been seen or heard of Stoltzer he was going down the alley, back of the old college building, trundling a wheelbarrow in which rested what seemed to be a half-grown barrel, with heavy staves, while from his left hip pocket protruded a faucet. The narrative being thus nearly finished, and feeling sure that more could be learned about Stoltzer by diligent search, ye scribe is going in search of Stoltzer, the barrel and the faucet. ninpls N 46202 Indianapolis,IN IndianaMedicalQuarterlyHistory IndianaHistorical Society 315 WestStreet 315 Ohio emtN. 3864 Permit No. Org. Nonprofit Indianapolis,IN U.S.Postage PAID R131 A! 15 V5 N04 015