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.
[Illustration: DOCTOR JOHN ESTEN COOKE.
From a Photograph.]
Doctor Cooke was in many respects a remarkable man, who acquired a
widespread reputation in this country, especially in the Mississippi
Valley. His fame was mainly built on his celebrated theory of the
universal origin of disease, which was, that disease was caused by
cold or malaria. That especially it commenced in weakened action of
the heart, resulting in _congestion of the vena cava_, its branches
and capillary distribution, and that fever was but the reaction of the
vital force to overcome this condition, which unrelieved would result
in death. According to him, all autumnal and malarial fevers were but
variations of one diseased condition, and even those fearful scourges
the plague, cholera, yellow fever, dysentery, etc., were simply varied
forms and conditions of congestion of the _vena cava_.
To destroy this many-headed hydra--while he would use cold water to
reduce too great febrile excitement and even sometimes give antimonial
wine[50]--his main reliance was on blood-letting and cholagogue
purgatives, as he believed it was by increasing the secretion of the
liver and causing it to pour out consistent "black bile" that the
venous congestion was to be relieved and the patient cured.
Amongst all these remedies calomel was his chief reliance, and was
given by him in doses not measured by the balance but by the effect
they produced; so that in the latter days of practice--notably during
the epidemic of cholera in Lexington in 1833--he absolutely resorted
to tablespoonful doses of this mercurial, repeated _pro re nata_;
actually giving about _one pound_ in one day to a young patient,
without fatal result.
Two cases may be quoted from his own paper in the _Transylvania
Medical Journal_, and from Doctor Yandell's _Memoir of Doctor Cooke_
in the _American 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.
On one occasion, having been brought into a somewhat febrile condition
by fatigue in a botanical excursion in hot weather, and having full
faith in the statements of Doctor Cooke to the effect that calomel was
of all antifebrile remedies the best, and that while a small dose of
calomel might prove irritating _a good large dose_ "would sometimes
act like an opiate," he took a one drachm dose in full confidence. But
instead of the soothing, curative effect he had been led to expect,
vomiting and severe irritation of the stomach resulted, so much so
that no food but boiled milk could be tolerated for a week or so
afterward. Shaken in his faith by his first experience, but not yet
convinced of the error of the doctrine of his respected preceptor, the
second trial of a drachm dose on a similar occasion completely
satisfied him that something wrong had crept into the theory and
practice of the honored professor.