INGENIERÍA BÁSICA

In 1845 Alexander Means (1801-1883) launched a spirited de- fense of calomel, asking rhetorically

[should physicians] consent to cower at the outcry of blind prej- udice, or ignorant and interested empiricism, and, before the eyes of the living myriads whom it has rescued from the jaws of the grave, deliberately pronounce the blistering curse of Science

upon its head, and consign it to the reproach and maledictions of posterity?

For Means, calomel was a mighty remedy—tried and true. It was, for him, “THE MASTODON IN HARNESS . . . [able] to do the work of an age in a year.”8

Others disagreed. Groups of botanic physicians had risen up against the therapeutic excesses of the “learned” regulars (dubbed allopaths). Men such as Samuel Thomson (1769-1843), Alva Curtis (1797-1881), Wooster Beach (1794-1868), and John King (1813-1893) challenged the “heroic” doctors with their debilitating bleeding and massive doses of calomel and antimony. For them, this behemoth was unhar- nessed and running amuck across the therapeutic landscape, leaving in its wake a populace robbed very often not only of their livelihoods but of their lives by the very masters of this much-praised and pre- scribed “pachyderm.”9

By the Civil War this movement of therapeutic iconoclasm had evolved from the Thomsonians into the physio-medicals under Curtis. Beach had long since faded away into obscurity in favor of John King, who had assumed the mantle of leadership for the Eclectic Medical Institute (EMI) of Cincinnati, chartered in 1845, the mecca of botanicism that would last well into the twentieth century. Arrayed with the botanics in their opposition to the heroic bleeding and purg- ing of the regulars were the homeopaths. Their elegant minuscule- dose preparations and sophisticated-if-recondite like-cures-like doc- trines appealed to some of America’s wealthiest and most influential citizens.10_{Homeopathy, founded by German physician Samuel Hah-}

nemann (1755-1843), was exported to New York City by Hans Gram, when he began his medical practice there in 1825. Homeopathy flourished and spread throughout the city. By 1844 the homeopaths of that city, and others such as Constantine Hering (1800-1880) of Pennsylvania, helped found a national institute. “After its initial pe- riod of spectacular growth in the 1840s and 50s,” writes Francesco Cordasco, “homeopathy continued to compete with the orthodox profession both in terms of personnel and institutional activity.”11

Thus by the mid-nineteenth century, American medicine had be- come an arena of professional animosity and therapeutic contention. Far from representing a hegemonic force in health and healing, regu- lar practitioners were being challenged on almost every front— schools, societies and associations, and theory and practice had be-

come emblematic of one’s professional affiliations; all of these com- peting forces were vying for scientific respectability.12

Nowhere was this more evident than in therapeutics. The deleteri- ous effects of persistent bleeding and massive dosing with toxic min- erals such as mercury (most commonly in the form of calomel) and antimony (usually prescribed as tartar emetic) became matters around which all sectarians could agree. The Eclectic Medical Journal, offi- cial mouthpiece of the EMI, voiced the protests of many when it de- clared,

Among all the absurd, irrational and fatal means made use of to restore the sick to health, there is none to compare with blood- letting. . . . In sickness we need all the strength and vital forces it is possible to command, and yet blood-letting is resorted to as a rapid method of depletion. Again, it is in violation of every law of physiology, and is never indicated by the natural efforts of the system to throw off disease.13

Although the regulars could argue that the practice of bleeding was in definite decline by the mid-nineteenth century, the same could not be claimed for mercury. “Of the poisons, among which the most inju- rious is mercury,” charged eclectic physician G. Price Smith in 1855. “There is scarcely a disease now treated by Allopathic physicians,” he added, “in which some preparation of mercury is not given; and what is worse, their text-books sanction this malpractice.”14_{In con-}

trast, Charles Wilkins Short (1794-1863), faculty member at Tran- sylvania University’s allopathic medical school, told his materia medica students that “none others equal in utility, excellence and uni- versal employment the preparations of Mercury and Antimony, for without the aid derived from these giant remedies, our art would be stripped of its main resources.”15_{William H. Cook (1832-1899), in-}

tellectual leader of the physio-medicals, explained in partisan terms the reasons for the regulars’ preference for mercurous chloride:

Probably no agent, whether of simple remedies or admitted poisons has ever received from the [allopathic] profession such universal and unqualified praise as calomel—subchloride of mercury. Among many admirable qualities ascribed to it, is that of inducing freer action of the liver, and thus securing a more abundant flow of bile and more regular movements of the bow-

els. We will admit that calomel favors such results. . . . But when it is claimed and admitted that calomel will induce these very advantageous results, only a part of the truth is stated. The

wholetruth includes the additional facts, that weariness of the liver always follows its stimulation by calomel; that congestion of it, with chronic enlargement and tenderness, very frequently ensues; and that hardening and abscesses, rather extensive ab- scesses, and even cancer of this organ, have often been found as ultimate consequences of the exhibition of this article.16

Cook essentially agreed with the diagnosis—torpid liver or bilious- ness was the source of most chronic disease. His argument was with the remedy. So physio-medicals, eclectics, and other sectarians at- tempted to adjust biliary secretions through the use of alternative cholagogues. Instead of calomel, many botanics prescribed Culver’s root (Leptandra virginica) and mayapple (Podophyllum peltatum) to do the same thing. In fact, mayapple was so frequently used by eclec- tics where calomel was indicated that it received the dubious distinc- tion of being called “vegetable calomel.” Dr. Charles Hempel of the Homeopathic Medical College of Philadelphia recommended cham- omile in numerous bilious complaints.17

Both the sectarians and the regulars were proceeding from two fundamental errors. The first error was diagnostic: the belief that im- proper liver function caused many diseases. This had a long tradition in medicine, a notion that was in some measure little more than a con- tinuation of Galen’s ancient concept of humoral imbalance.18_Galen

suggested that the liver was the source of veins and that it was the or- gan responsible for the manufacture of blood, thus making it a central feature of his humoral theory. William Harvey’s 1628 work on the circulation of blood, De motu cordis, challenged this idea; however, this refined knowledge of liver function did not reduce the impor- tance of that organ in the etiology of disease. Dr. James Johnson gave the conventional wisdom of the day in noting,

The liver is the largest gland, or organ of any kind, in the human fabric. . . . Now, as the organ exists in almost every class of ani- mals, even where other important viscera are very imperfectly developed, we may fairly conclude, that it answers some great purpose in the animal economy.”19

This idea that the liver was the source of many illnesses led to the second fundamental error, which was therapeutic: the notion that an imbalance of biliary secretion was the root of the problem and that this could be manipulated through the administration of calomel or some vegetable substitute.20_{After recounting the many afflictions to}

which biliary imbalances could be ascribed, Johnson spoke for the regulars by declaring, “As an internal medicine, there is none which so steadily increases and meliorates the hepatic secretion as some of the mild preparations of mercury.”21

This concept had been tested in animal experiments during the 1850s. The mounting evidence suggested that calomel, in fact, did

nothave any influence over biliary secretions, and in 1868 the Edin- burgh Committee’s report published by Dr. J. Hughes Bennett in The

British Medical Journalthoroughly refuted the idea of calomel as a biliary stimulant. Nonetheless, the medical community’s faith in cal- omel as a valuable cholagogue remained unshaken.22_{The persistence}

of this stubborn adherence to calomel derived from physicians’ at- tachment to tradition and overreliance on empirical observation. The stools evacuated by a patient dosed with calomel were greenish in color due to the presence of biliverdin. This alone suggested increased hepatic activity, but what the nineteenth-century physicians did not know was that this greenish color resulted not from more bile produc- tion but rather from the antiseptic action of mercury, which did not al- low the normal conversion of the bile pigment in the bowel due to its violent cathartic action. In short, the intestinal contents were dis- charged too rapidly for the biliverdin to convert normally into biliru- bin.23

Unswervingly faithful to their medical forebears in bestowing the liver with major powers over the human constitution, and convinced that their eyes were not deceiving them, regulars remained stead- fastly devoted to mercurous chloride as a significant weapon in their armamentarium.24_{The sectarians on the other hand often agreed with}

the diagnosis only to argue over the specific agents to be employed to achieve the desired result.

Specific lines of therapeutic demarcation between allopaths and sectarians were often distinguished by only one ingredient, such as mercury, with additional substances blurring into a sea of commonly prescribed plant-based drugs. The standard American pharmaceuti- cal text for the period, Edward Parrish’s Introduction to Practical

Pharmacy, recommended a compound cathartic pill made up of 1 grain of calomel augmented by some plant cathartics commonly used by eclectics: 1½ grain of colocynth, 1 grain of jalap or podophyllum (whichever was available), and one-fifth grain of gamboge. Parrish declared,

Under the name of anti-bilious pills, this preparation is vended in great quantities over the country, and by its admirable combi- nation of cathartic properties, is well adapted to supersede as a popular remedy, the numerous nostrums advertised and sold for similar purposes.25

It was within this context that therapeutic matters came to a head during the Civil War. Sectarians were clamoring for recognition of their “gentler” therapies; regulars were earnestly defending their “proven” remedies; everyone was convinced that the liver was of con- siderable importance as a source of systemic disease. Moreover, these convictions were not divided by region. Just as Northern physi- cians were convinced of the preeminence of the liver in the human constitution, so too were their Southern colleagues. It is no mistake that the longest article in the relatively short fourteen-issue history of the Confederate States Medical and Surgical Journal was a two-part essay by H. D. Schmidt titled “On the Microscopic Anatomy, Physi- ology, and Pathology of the Human Liver.”26_{Schmidt believed the}

liver took on added importance in hot summer months, declaring, This organ, notwithstanding its participation with the other or- gans in the general relaxation of the system, and with scarcely sufficient ability to perform properly its own functions, is called on to assist the lungs in the elimination of carbon. In some cases it may succeed in performing the additional function, but in others a congestion of its blood vessels is the result. . . . Such a congestion, if persistent, gives rise to various complaints, as hemorrhoids, pain in the bowels, stomach, & c., and will even keep up an existing diarrhea or dysentery. The pain in the stom- ach or bowels is not acute, but, on the contrary, dull and heavy, resembling very closely the pain experienced in dyspepsia. A number of these cases has come under my observation, and I have cured them by relieving the congestion in the portal circu- lation.27

Undoubtedly, that “relief” came in the form of calomel.

Despite the long-standing tradition of these agents in the regulars’ armamentarium, some members of the allopathic community had al- ready reacted against the abuse of these substances and against heroic therapeutics in general. The medical elite of Massachusetts consisted of leading figures such as James Jackson, Oliver Wendell Holmes, and Jacob Bigelow—all of whom placed great faith in nature’s ability to heal and became vocal proponents of therapeutic moderation. In- deed, Bigelow, echoing Molière more than 200 years earlier, sug- gested that most disease left alone without treatment of any kind was self-limited and would resolve itself.28 _{During the war years some}

forward-thinking physicians such as James L. Brown were beginning to take the Bennett studies seriously and doubting the value of mercu- rials as biliary stimulants.29

But most practitioners remained steadfast in their use of mercuri- als and antimony.30_{All during the Civil War they remained important}

articles of allopathic practice and faith. Even so, noted authorities Charles S. Tripler and George C. Blackman recommended tartar emetic in treating dysentery in their Handbook for the Military Sur-

geon.Faced with a case of dysentery, they gave “at once a purgative dose of sulphate of magnesia j combined with ¼ to ½ a grain of tar- tar emetic.”31_{Well after the war physicians continued to vehemently}

defend the use calomel in a variety of disorders.32

Calomel’s War Casualty: William Hammond

The young, ambitious, and progressive Surgeon General William A. Hammond (1828-1900) had his own doubts about these heroic ap- proaches to therapeutics. By spring of 1863, he had seen enough. Re- acting to what he felt was the unbridled use of these substances among his medical corps surgeons, Hammond made a fateful deci- sion to remove calomel and antimony from the standard supply table. In an order that was issued as Circular No. 6 on May 4, the Surgeon General “struck from the Supply Table” calomel and antimony be- cause of their being “pushed to excess” and concluded that to keep ei- ther item available to the medical staff would be “a tacit invitation to its use” (see Appendix B).

The response of the sectarians and the regulars was swift. For the botanics, Hammond’s order was heralded as a great leap forward for

the healing arts. John King of the Eclectic Medical Institute spoke for many irregulars when he declared,

For our part we are glad to see that our old school friends are ad- vancing in the right direction, and feel satisfied that the order of the Surgeon General will hasten the day when mercurials will be entirely discarded in the treatment of disease.33

John King hit an especially sensitive professional nerve when he pointed out, “If the Old School discarded their poisonous minerals entirely, what will be the difference between them and the Eclectics . . . ?”34

King had made an important point, and the allopaths knew it. Dr. E. P. Bennett of Danbury, Connecticut, fumed,

If I were an army surgeon, I should consider such an order as a direct impeachment of my capabilities, and offer my resignation at once. Besides, this order is calculated to bring these two im- portant remedies into great disrepute with the public, and give aid and comfort to our enemies, the quacks.35

Calls for Hammond’s removal from office soon followed. The com- mittee formed by the American Medical Association to investigate Hammond concluded that Circular No. 6 was “entirely unwarranted” and constituted an “unmerited insult” that “this Association con- demns, as unwise and unnecessary.”36

Hammond was a bright and talented administrative reformer, but many of his reforms (needed though they were) incurred the wrath of his colleagues. In addition, Hammond had increasing disagreements with his superior, Secretary of War Edwin M. Stanton. Thus by 1864 Hammond had lost valuable support both within the Union medical corps and Lincoln’s cabinet. The issuance of Circular No. 6 repre- sented nothing short of professional treason. For most of his allo- pathic colleagues this was the last straw. On January 17, 1864, Ham- mond was arrested to face court-martial. The court preferred three charges against Hammond: (1) “Disorders and neglects to the preju- dice of good order and military discipline”; (2) “Conduct unbecom- ing an officer”; and (3) “Conduct to the prejudice of good order and military discipline.”37_{The chief complaint was that Hammond had}

“wrongfully and unlawfully, and with intent to favor private persons,” ordered blankets from one Christopher C. Cox, an acting purveyor in

Baltimore, to receive blankets from William A. Stevens from New York.38 _{In addition, he was charged with purchasing from John}

Wyeth, a Philadelphia College of Pharmacy graduate who—along with his brother F. H. Wyeth—ran a large and successful drugstore on Walnut Street in that city,39 _{medical supplies allegedly “inferior in}

quality, deficient in quantity, and excessive in price.”40_{The charges}

themselves were groundless and ably defended by the surgeon gen- eral, who pointed out that the “facts” of the case were “not set out or in any way shadowed forth by specifications.”41_{Unfortunately, Ham-}

mond’s energetic reforms, especially removing the old seniority sys- tem of promotion within the medical corps in favor of advancement based on merit, had lost him the support of his colleagues.

By summer, a weak and compliant review board found Hammond guilty, and he bid a reluctant farewell to the medical corps on August 22, 1864. He was succeeded by Joseph K. Barnes (1817-1883), who continued most of Hammond’s programs, a tacit admission that his predecessor’s troubles were due more to personality conflicts and po- litical machinations than job performance.42_{Great Britain’s medical}

community, which could assess the Hammond controversy objec- tively, gave a noteworthy response:

Of course all the charges relating to purchases imply a fraudu- lent intent on Dr. Hammond’s part, but when the prosecution failed in proving this it charged him with exceeding his author- ity. It appears to us that every one of the acts laid to his charge . . . comes within the ordinary duties of the head of the Army Medical Department. But Dr. Hammond was unlucky enough to fall out with Secretary Stanton.43

An official inquiry would later substantiate this observation. In 1878, a Senate Military Committee reviewed Hammond’s court-martial and found that the charges stemmed largely from personal conflicts with Secretary of War Stanton and not from any dereliction of duty or improper conduct. It fully exonerated him, restored him to the U.S. Army, and appointed him to the rank of Brigadier General (retired).44

But the damage had been done. “The old-guard’s victory had long- lasting effects,” writes historian George Worthington Adams. “As the older men began to get the important posts the best young men tended to leave the service. There was an end of new ideas, and after 1865 a partial relapse into ante-bellum lethargy.”45

Hammond lost because his removal of calomel and antimony placed him directly in the therapeutic cross fire that persistently raged between allopaths and sectarians. But was Hammond’s order even necessary? At least one historian sees Hammond’s action as precipi- tous, arguing that Circular No. 6 failed to establish that calomel was so widely abused as to warrant its immediate removal.46_{Circular No.}