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.