Chapter 4

Although his taste and talents inclined him to the legal profession he was induced to study medicine, somewhat against his own judgment. His medical education was obtained in Philadelphia, in the Medical Department of the University of Pennsylvania, then the only medical college in America, which he entered in 1792, and from which he graduated. While there he industriously employed his time and faculties in study, debate, and discussion, and his pen in numerous publications, the principal of which was a translation of Blumenbach's _Elements of Physiology_--which he completed before graduation. He managed to antagonize, amongst many others, his medical preceptor, the celebrated Doctor Rush, much to his own detriment, as he in his autobiography acknowledges.

In the following year, 1793, on the outbreak of the yellow fever in Philadelphia, he distinguished himself by his courage and self-sacrifice in voluntarily attending and nursing the sick. And again, by his pen and otherwise, in theoretical discussions on the origin of the pestilence.

According to his own representations and the testimony of his friends, he was exceedingly methodical in his habits, dividing his time with rigorous system; but we may well feel a little skeptical as to his assertion that he "rarely slept more than four hours," and at one time but three hours and a half. His mental activity and labor, however, in his youth, must have been very great. Apart from his necessary studies and his active and constant participation in the discussions of the Medical Society, he delivered more public addresses, for the Society and on other occasions, "than all the other members of the institution united" (Page 254), besides employing his pen in numerous ephemeral productions for the press.

In speaking of his early life in Philadelphia (Page 330) he says: "I was a young man for the scenes in which I had acted; proud and ambitious certainly, and probably not altogether untinctured with vanity.... In truth it is hardly to be denied that, for a time at least, I was somewhat spoiled [by the compliments paid him] on account of my attributes and performances, both mental and corporal.... No wonder, therefore, that I felt, or conceited I felt, a decided superiority to most medical pupils, as well as the ordinary cast of young physicians.... I certainly did both indulge and manifest it to the extent, at times, of giving serious offense." This was not the worst. His bold self-confidence and assertion having placed him in a position of antagonism toward his friend and preceptor, Doctor Rush, as well as toward other influential medical men of Philadelphia, defeated the great ambition of his life--that of occupying the chair of the Institutes of Medicine in the Medical College of the University of Pennsylvania.

When informed by Doctor Rush (Page 290, autobiography) that although his friends spoke in flattering terms of "your talents, attainments, and powers in lecturing and instruction ... they are reluctant to recommend you to the Board of Trustees in the light of a professor," he indignantly declared that "if the door of the University of Pennsylvania was thus closed to him he would soon occupy a chair equally honorable with that of Doctor Rush in some other school." And he shortly thereafter was induced to push his fortunes in the great and growing West.

Coming to Lexington with his shining and commanding talents, his determination to conquer success, and the brilliant reputation he then had as an independent writer and lecturer; to become associated with the yet more brilliant President Holley, and the already well-known and appreciated medical teachers, Doctors Dudley and Brown; at an auspicious time when the rapidly improving country felt the want of medical instruction at home--the rapid success of the Medical Department of Transylvania (to which he materially contributed by his able efforts before the public) might well excuse him in his belief[41] that he had come to Lexington to be the "_premier of the school_,"[42] that he had come to train and induct his colleagues ("a most miserable Faculty," he calls them) into efficiency and fame, and that the success of medical education in Lexington was due mainly to his individual efforts. Candor obliges us to admit, however, that there is some truth in the statement of the late Professor Yandell, in the memoir above quoted. Doctor Yandell was a student in the Medical Department of Transylvania in 1823, and a most ardent admirer of the brilliant talents of Professor Caldwell, yet he found that both Professors Dudley and Drake were more popular with the students, as teachers, than he. He says (Page 56): "Students, in truth, generally turned listlessly away from his polished discourses on Sympathy, Phrenology,[43] the Vital Principle, and other kindred themes, and hurried off to the lectures on Materia Medica and Anatomy."[44]

In short, Doctor Caldwell excelled in the brilliant discussion of speculative and theoretical subjects. The extent of his positive knowledge, as remarked by Doctor Yandell, was greater in superficial area than in depth; whilst in the terse and lucid exposition of definite facts, which characterized the instruction of Professor Dudley, the student felt he was acquiring knowledge which not only was real but was of practical utility.

The history of the _rise and fall_ of this school of medicine is illustrated in the detailed list of its classes and graduates as shown in the annexed _Schedule B_.

The total number of students in the Medical School of Transylvania during the term of its existence was, as far as can now be ascertained, more than six thousand four hundred (6,456); the total number of its medical graduates eighteen hundred and eighty-one (1,881).[45] During the late civil war the commodious Medical Hall of Transylvania, built in 1839 by the munificence of the city of Lexington, and which had been seized by the United States Government for use as a United States General Hospital, was destroyed by fire while occupied for that purpose.[46] But the medical library,[47] apparatus and museum, etc., were mainly preserved, and are now in the custody of the Curators of Kentucky University, with which institution old Transylvania University was consolidated in 1865, "all the trusts and conditions" of her property being preserved in the Act of Consolidation.

The Medical Department may yet be resuscitated when in the course of events our city again becomes an eligible site for modern medical instruction, and when special means can be obtained properly to equip and re-establish it on a basis suited to the existing times.

The gradual decline of this school, like its rapid rise, was due greatly to the changing conditions of the country. When, shortly after 1812, steamboat navigation began to manifest its superiority and influence on the channels of commerce, population and business deserted measurably the interior routes and locations and transferred themselves to the river valleys and neighborhoods. Gradually during this change--notwithstanding the talents, ability, and fame of our Brown, Dudley, Caldwell, Cooke, Short, Yandell, Bartlett, Mitchell, Smith, and others, and the generous support of the city--the school declined; more especially because of the establishment of rival colleges at more eligible points, in growing and populous cities. Lexington lost its pre-eminence as the "_Metropolis of the Western Country_," and Cincinnati, Louisville, St. Louis, and other places which had been villages supplied with her manufactures, rapidly became great cities; while she declined from a population of about eight thousand in 1814, down to a little over four thousand in 1820, with an immense loss to her citizens in the value of her property and the destruction of her industries. In this year (1820) the population of Cincinnati, which in 1810 had been only two thousand, three hundred and twenty, had risen to nine thousand, six hundred and forty-four; and in 1830, when the population of Lexington was yet only five thousand, six hundred and sixty-two, that of Cincinnati was twenty-four thousand, eight hundred and thirty-one. When the present writer came to Lexington in 1832 the population had remained nearly the same, and an era of decrepitude and decline of all her industries still prevailed. Lexington had not yet finished her first railroad.

This railroad, the "Lexington & Ohio," was begun in 1831 and completed as far as Frankfort--twenty-eight miles--in 1835. It was composed of stone sills laid side by side, with a dressed surface on the portion upon which the wheels were to run. The cars resembled an old pattern of street car and were drawn by horses.

The imposing ceremony of laying the first "stone sill" took place on Water Street, October 21, 1831, "amid a vast throng of people." Indeed, it was made a very great occasion, which might have been marked with still greater pomp and circumstance, as the newspapers inform us, had "more notice been given beforehand." As it was, a large procession, civic and military, was formed, marshaled by General Leslie Combs, the renowned "boy-captain of 1812," assisted by handsome James B. Coleman. Three military companies, including "Hunt's Artillery" and "Captain Neet's Rifle Guards," were on parade with a fine military band playing "Yankee Doodle," "Hail, Columbia," and other patriotic airs. Major-General Pendleton and staff, on horseback, led the march. Governor Metcalfe and Reverend Nathan H. Hall supported the orator of the day. The Trustees of the town, the President and Directors of the railroad, the President and all the officers and Trustees of Transylvania University, and all the societies of the University and of the town, were in line. "At eleven o'clock," says the _Lexington Reporter_, "the three military companies which formed the escort marched from the place of rendezvous to the college lawn, where they were met by the various societies and individuals. For many years we have not witnessed such a pageant, and never a more interesting.

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

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

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

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

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

But in later days, in competition with the steamboat, the newer and swifter mode of transportation--the railroad--has been gradually but surely restoring to the inland regions, and to Lexington, their lost prosperity. Our city has steadily risen to about seventeen thousand (1873), with a good prospect of a further increase of prosperity and population as railroads centering here may be extended. Then may we hope to put into active operation once more our time-honored Medical College, and to attract to it a creditable number of students. More particularly if, with the co-operation of the more enlightened members of our profession, an effort be faithfully made in the renovated college to bring about the much-needed reform in medical education, the necessity for which is now generally recognized. So that the mere fact of a student attending two courses of lectures, with other somewhat easy requisitions, may not entitle him to the degree of Doctor of Medicine, as has been too frequently the case amongst competing medical colleges. That full preparation and training, in a sufficient period of time, shall be required of the candidates into whose hands the health and lives of communities are to be committed. On such a basis--when our city may have acquired increased facilities for clinical instruction, and when anatomical studies will not be cramped for want of means of demonstration--the old Medical College of Transylvania may revive under the wing of a people's educational institution such as Transylvania is and always was--a "_State University_."

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

Doctors Cooke and Yandell, and finally Doctor Short, joined Doctor Caldwell to aid in the establishment of the _Louisville Medical Institute_. Professors Dudley and Richardson and the assistant professors, Bush and Peter, remained in Lexington. The celebrated Professor John Eberle was called to the chair of Theory and Practice, but he died shortly after the delivery of his introductory lecture. Professor Thomas D. Mitchell was appointed to the chair of Chemistry, etc., and Doctor James C. Cross to that of the Institutes of Medicine.[49]

DOCTOR JOHN ESTEN COOKE

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

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

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

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

Two cases may be quoted from his own paper in the _Transylvania Medical Journal_, and from Doctor Yandell's _Memoir of Doctor Cooke_ in the _American Practitioner_ for July, 1875. "William Douglass, a student of theology, nineteen years of age, took a tablespoonful (about two ounces) every six hours for three days in succession, having taken the same quantity the evening before; in all, thirteen tablespoonfuls. He was in collapse when he took the first dose. On the third morning after beginning this treatment his discharges were found to have become thick and green, and Doctor Cooke thought he would have recovered but for the indiscretion of his attendant, who had him to walk across a large room from one bed to another more than once. Hiccough came on, the patient became delirious, and died on the sixth day. But another patient recovered about this time under similar treatment, and still lives, I believe--a useful Episcopal clergyman, and an illustration of the extent to which calomel may be employed in some diseases without injury to health. Mr. Brittan, a young theological student, took a tablespoonful of calomel soon after having had several copious watery discharges. He was advised to repeat the dose every six hours, until the watery discharges ceased. He took, that day, four and on the next, three of these doses; the discharges not ceasing until some time after the seventh dose had been taken. He took, moreover, three similar doses during the same time--having thrown up three. The _repeated doses_ were given immediately after the regular ones were thrown up. Bilious discharges appeared on the evening of the second day, and were kept up by tincture of aloes and occasionally pills of aloes and rhubarb for a week. The patient was somewhat salivated, but recovered. I saw him a number of years afterwards in perfect health."

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

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

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

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

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

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

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