10

Calomel, Cholera, and Science

1825-1865

Thomas Jefferson charged that medical science had not advanced since ancient Greece and Rome—he contended that “time had stood still” and that it was dangerous to come under the treatment of a physician. He wrote to physician Caspar Wistar on June 21, 1807, that a revolution was needed because a physician would propose “some fanciful theory” and declare that it was a new key to understanding that gave him unique insight into all nature's secrets. He wrote that he had seen systems come and go “like the shifting figures of a magic lantern” and that the patient “sometimes gets well in spite of the medicine.” On the other hand, Jefferson realized that the best physicians had dissected human bodies and had knowledge of anatomy. Having lost his wife in childbirth, when his daughter Maria was preparing to deliver, he advised her to alert a physician and be ready to call him “on the first alarm.” Ephraim McDowell taught his apprentices that the all-purpose laxative calomel and other drugs were quackery and did more harm than good. Surgery, he said, was the only branch of the healing art that was reliable.¹

The revolution Jefferson demanded would not come until the discovery of bacteria generations later, and one wishes for a time machine to travel back to the early nineteenth century to dispel the darkness with the discoveries of modern science. Jefferson and early Kentuckians lived in a time, beginning about 1750, when medical science was divided into two extremes. Extreme empiricists emphasized sense impressions and mistrusted all intuition and theories, while extreme rationalists developed elaborate theories of disease and treatment based on theories. Influenced by scientific breakthroughs in mathematics, physics, and other fields, doctors following both empiricism and rationalism searched for the revolution, for the “one key to open all doors” that would make the theorist the Sir Isaac Newton of medicine. All their “breakthrough” systems began with what medical historian Charles E. Rosenberg called the central body metaphor, a theory dating back to the second-century Greek physician Galen. It was the idea that, when the human body is in balance, the person is healthy but that, when it gets out of balance from a change in the weather or some other cause, sickness results. Galen concluded that the body had four humors—black bile, yellow bile, blood, and phlegm—and that, when one is in excess, equilibrium and health could be restored by removing the excess humor by bleeding, purging, and perspiring. New theories arose in the later half of the eighteenth century, but they all began with the central body metaphor.²

English physician Thomas Sydenham claimed that his modification of the Greek humoral theory was the key. He taught that illness was caused by tiny particles of peccant or foreign matter that invaded the body and produced fermentation that made the person sick. The cure was to remove excess foreign matter with the same purgative methods as Galen. However, more influential in Kentucky history was the theory of William Cullen, a highly respected professor at the University of Edinburgh. Cullen taught Benjamin Rush, who in turn taught at the University of Pennsylvania and was the most influential medical theorist in the United States in 1800. Cullen said that the cause of illness was the loss of nervous force in the capillary walls and that the cure was the restoration of nervous energy in the body through the same purging treatments.³

In Philadelphia, when the great yellow fever epidemic of 1793 occurred, Rush reasoned that there was only one disease in the world and that it was caused by tension or “excessive action” in the capillaries. He avowed that disease was harsher in America because both cold weather and hot were more extreme; therefore, the cure must also be more rigorous. He blighted Americans of the early nineteenth century with heroic medicine, the most extreme bleeding and purging in the history of medicine, far more extreme than treatment in Europe. Heroic therapy was an American phenomenon that treated seriously ill patients by removing three-quarters of their blood and giving them extreme diarrhea from huge doses of the calomel. Rush taught that the great fear was that the doctor would timidly stand by and not save the patient by taking enough blood or purging enough. He said that anyone could observe that his system succeeded because, when the feverish, restless patient was bled, he or she would relax and appear to be resting. Within a few minutes, bleeding lowered the temperature, relieved delirium, and replaced flushed skin with healthy-looking paleness and copious perspiration that seemed to prove that the fever was broken. The system was called heroic because, when the doctor came, he was a hero for taking such extreme action and producing such immediate, obvious results.⁴

In the 1793 yellow fever epidemic, Rush's treatment contributed to the suffering of his patients, but he emerged as a popular hero. When several other doctors fled in fear, he remained and treated over one hundred patients per day. He was a warm, humane, and positive person whose presence uplifted the spirits of his patients. He was famous; he had been elected to the Second Continental Congress, signed the Declaration of Independence, and in the Revolutionary War had served as surgeon general of the Middle Department. Jefferson asked him to give medical advice to Meriwether Lewis for the Lewis and Clark expedition. He was the most popular and most influential medical teacher in America, and his new doctrine and his promulgation of it “meant that for many years to come massive purging and bloodletting were to characterize American medical practice.” At the time of his death, he was known as the father of American medicine and was called—then and now—the “American Hippocrates.”⁵

The ancient Greek system lasted so long because it was logical and doctors and patients had confidence in it. This was also the case with heroic medicine. Americans wanted medicine that worked, and all the treatments worked. Bleeding lowered the pulse rate, and bleeding and purging lowered body temperature and quieted agitation. Obviously, it appeared, the doctor restored balance to the body. Calomel was mercurous chloride, it always produced diarrhea, the common dosage produced the involuntary salivation of mercury poisoning, and this elimination of saliva was considered laudatory. It was severe, but the severity assured the patient that something was being done. Logic and nearly two thousand years of clinical experience appeared to show that it worked. An ancient proverb said, “Physician, heal thyself!” and the heroic doctors attempted just that—they diligently treated themselves and their families with the heroic regimen.⁶

Rush had great influence on medical practice and the teaching of medical theory in Kentucky. He taught several prominent Kentucky doctors, but the one who most faithfully carried his banner was Dr. John Esten Cooke, Transylvania University professor of the theory and practice of medicine beginning in 1827. Cooke was born in Boston, son of a Revolutionary War surgeon, and earned his M.D. degree under Rush in Philadelphia in 1805. He established a successful practice in Virginia and in 1827 came to Lexington with his wife and their ten children. Dedicated to the classics, he carried a Greek New Testament in his pocket. He was earnest and sincere, and, as with Rush, his presence inspired confidence in his students and patients. He had an impressive appearance, with deep-set eyes, a large nose and large ears, and a thick head of tousled hair. Cooke expanded Rush's theory into a more comprehensive system. It had long been believed that a malfunctioning liver could cause illness, and it had long been believed that miasmata or bad air rising from filth could corrupt the body's humors. In his three-volume book on the theory of medicine, Treatise of Pathology and Therapeutics, published in 1828 when he was in Kentucky, Cooke asserted that gases or bad air caused congestion in the blood vessels and liver and that the cure was to remove the congestion with massive doses of calomel. He taught that calomel was to be given to salivation and until bowel discharges turned black, indicating that the liver was being cleansed of excessive bile.⁷

Cooke's doses of calomel demonstrate that he was one of the most extreme practitioners of Rush's heroic therapy in America, and his patients and those of his medical students suffered the consequences. In 1826, he gave an extremely sick young woman 240 grains in twenty-four hours, and she died. He gave a young man one pound in one day, and, after his discharge turned thick and green, he improved and recovered. Usually, however, before the cholera epidemic of 1833, Cooke reserved such huge doses for patients so near death that massive purging seemed the only way to save them. When cholera struck Lexington, he hastened home from a trip to Philadelphia and became the hero of the epidemic just as Rush had in the yellow fever epidemic. He ignored the danger—three other Lexington doctors died of cholera—and dashed from house to house administering calomel. After that, he routinely prescribed large doses and marketed “Cooke's Pills”: equal parts calomel, aloes, and rhubarb.⁸

Cooke's students adored him and gave him credit for discovering the key to medicine. One recalled: “Because of its simplicity and its apparently logical basis, the system of Doctor Cooke was very attractive to students of medicine.” His colleagues stated that Cooke would have gladly died a martyr for his beliefs, and, indeed, he came close. By the time he transferred to the Louisville Institute of Medicine in 1837, heroic therapy was falling into disrepute. Samuel F. Miller, one of Cooke's students, opened a practice in Barbourville and diligently used the regimen Cooke taught. However, after a few years, Miller became frustrated with his failure to relieve suffering from cholera and other diseases. He left medicine, became a lawyer, and moved to Iowa, where he was a congressman when Lincoln appointed him to the Supreme Court. By 1843, Cooke's mentor, Dr. Rush, was widely condemned in America, and that year Cooke resigned from teaching. His faculty colleagues were ridiculing him as “the high priest of calomel,” and his students had petitioned for his removal. He retired to his farm near Louisville and in the fall of 1844 became seriously ill with chills and fever. He took his calomel pills and had himself bled, but his condition worsened, and his family feared he was dying. It was time for more scientific medicine; therefore, they summoned Dr. Robert Peter, dean of the faculty and a professor of chemistry and pharmacy at Transylvania University. Peter rejected Cooke's heroic practices and was well aware that, since 1827, quinine had been recognized as valuable in treating fever. He prescribed quinine, and Cooke recovered and lived another nine years, to the age of seventy, dying in 1853. Quinine was the prescription most used in the Civil War for all fevers; it was known to be especially valuable in treating and preventing malaria.⁹

Physicians in the early nineteenth century left few detailed case histories, and, when they reported on cases, it was usually to justify themselves and make it clear that they acted heroically in an attempt to save their dying patient. George Washington's three physicians published a detailed report of how they treated him because of his status and because at the age of sixty-seven he went from excellent health to death in one day from an acute throat infection. In Hopkinsville in 1825, Dr. John F. Henry wrote a detailed case history of how he treated Peyton Short because he wanted to assure Short's son, Dr. Charles Wilkins Short, a friend in the profession, that he had done the best he could for Charles's father. Charles Wilkins Short was a prominent medical professor at Transylvania University. Henry related how he used heroic therapy and would have gone further had the patient not refused. Henry was a Scott County, Kentucky, native with an M.D. degree from the College of Physicians and Surgeons in New York City and was practicing in Christian County. He was summoned to examine Peyton Short at his home on his five-thousand-acre farm near Hopkinsville. Short was sixty-three years old and had been in good health until a few days earlier. He was born in Virginia, came to Kentucky in 1784, served as a state senator for Fayette County, and in 1817 moved to the farm in Christian County.¹⁰

Peyton Short told Dr. Henry that he was suffering from chills and fever, nausea, and intense pain in the stomach. Henry treated him with bleeding, calomel, blistering, and opium for pain relief. In his report, he carefully explained that he wanted to use “large doses of calomel frequently repeated” but that Short had such a “great prejudice” against calomel that it was impossible. Henry initiated treatment at 10:00 P.M. on August 28, 1825, and Short died four days later at 4:30 A.M., September 1. It is clear that Henry's treatment dehydrated Short and increased his suffering—Short would have been better off physically without the debilitating regimen. “Faced with a life-and-death situation,” wrote the editors of the case report for the Filson Club History Quarterly, “the physician of that era did not hesitate to use any possible therapy no matter how debilitating or harsh.”¹¹

On the other hand, even in the heyday of heroic medicine, some professors taught a less rigorous system of bleeding and purging, and their students treated their patients accordingly. One of Cooke's classmates under Rush was William Richardson, who joined the faculty of Transylvania in 1817 as professor of obstetrics. Richardson was a man of common sense and integrity, and he was a practical person who minded his own business and wanted to avoid conflict. But, on a faculty of outstanding, forceful personalities, that was next to impossible, and he was drawn into the fray. Richardson's close friend was Dr. Daniel Drake, professor of materia medica and medical botany. Drake and Benjamin Dudley quarreled over some issue involving a postmortem examination of a patient, and Dudley challenged Drake to a duel. Drake refused, and Richardson felt compelled to uphold Drake's honor by acting as his substitute. On the dueling field, Richardson's pistol ball missed Dudley, but Dudley's bullet struck Richardson in the groin, severing an artery. Richardson was in danger of bleeding to death. Dudley rushed over and pressed his thumb against the artery above the wound and halted the bleeding until Richardson's surgeon applied a ligature. Richardson's life was saved, and from that moment he and Dudley were fast friends for the rest of their lives.¹²

Physicians searched for an effective treatment of consumption or pulmonary tuberculosis, one of the killer diseases in Kentucky. Applying the scientific method of experimenting, Dr. John Croghan supervised a dramatic project that he hoped would make Mammoth Cave famous in medical history and attract many visitors to Kentucky. He was a nephew of George Rogers Clark, and he grew up at Locust Grove, the Clark family home in Jefferson County. He earned an M.D. degree from the University of Pennsylvania in 1813 and in 1823 helped organize the Louisville Marine Hospital for transient riverboat crewmen. He directed the hospital for about nine years, but, when his younger brother, Charles, contracted tuberculosis, John resigned and went with Charles to Europe, where it was hoped Charles would recover. The change in climate did not help, and Charles died in Paris. John began searching for a cure and decided to combine it with his longtime dream of purchasing Mammoth Cave and promoting it as a tourist attraction. In 1839, he purchased two hundred acres that included the cave and began preparing for the experiment. Climate change was regarded as a cause of illness, and he theorized that the uniform temperature of about sixty degrees Fahrenheit in the cave might cure the illness.¹³

In a chamber 160 feet below the surface, Croghan erected cabins. Most were built of lumber, but a few were of stone; all had canvas roofs. Today, park guides on the Star Chamber Tour point out the ruins of the stone cabins. Croghan recruited fifteen patients; they moved into the cave in 1841. Croghan served as resident physician and strived to make the patients comfortable, but in order to have light during their waking hours they had to burn oil lamps. These and the stoves for cooking and heating filled the air with smoke and caused patients to cough. Croghan was considering the erection of an air shaft in 1843, but after two years he decided to end the project. The patients had showed no remarkable improvement, and at least four had died. He continued promoting the cave and made it world famous. He died six years later in Louisville of the disease he attempted to cure.¹⁴

The time of greatest fear and panic for Kentuckians in the first half of the nineteenth century was during the Asiatic cholera epidemic of 1833. Probably the next most frightening was the period of the New Madrid, Missouri, earthquakes of 1811 and 1812. There were four major earthquakes, which destroyed homes and public buildings in Henderson and Mortons Gap and caused minor damage as far east as Maysville. By the fourth and last major quake, some excitable people feared that it must be the end of the world. But the apprehension was apparently nowhere approaching what it was in many communities when cholera struck. One of the most horrifying aspects was that you could follow the advance of the disease on the map as it moved toward your home; it was the “dread of impending danger” and more fearful than fighting a battle, recalled a Kentucky combat veteran.¹⁵

Families fled from their homes and raced out of town attempting to escape from the monster of spreading sickness and death. One observer later compared it to the stampede of Unionists out of town when John Hunt Morgan's raiders approached. During an outbreak, a person might wake up healthy in the morning and be dead by nightfall. On the street, a person in perfect health would suddenly collapse with spasmodic diarrhea and vomiting and be dead within a few hours. In Lexington, a daughter buried her mother in the afternoon and went home to nurse her father, who died before the next morning. Irrational, horrifying rumors spread through the community. In Winchester, frightened residents said that green vapor appeared in their homes and caused meat to spoil within an hour. An eerie silence came over Lexington; people with pale faces and dread in their eyes passed each other on the street without speaking. Kentuckians battled many diseases in that era, including smallpox, yellow fever, typhoid fever, dysentery, measles, scarlet fever, tuberculosis, malaria, and influenza, but none were as frightening as cholera.¹⁶

The pandemic began in India in 1826, and, by 1831, it had spread to Great Britain. In the spring of 1832, it crossed the Atlantic, probably on crowded immigrant transports, and was reported in New York City in early June. It spread along the Atlantic coast and up the Hudson River, along the Erie Canal and down the Ohio River. In early October, a cook for a passenger steamboat died of cholera in Louisville, and, by early November, the board of health reported 122 deaths. There were cases in Maysville, Henderson, Frankfort, and Bardstown. The Louisville Public Advertiser warned that the disease was caused by bad air, called effluvium, or miasma, which emanated from garbage or filth. The newspaper warned people to avoid nursing the sick when hungry or exhausted. Rumors circulated that to be safe one should avoid all contact with the sick and especially with the dead. Lexington reported only five deaths; the disease disappeared after a heavy frost in mid-November.¹⁷

When warm weather returned the next spring, however, cholera came roaring down the Ohio River again. On the afternoon of May 29, 1833, a rumor spread in Maysville that several people were sick, and twenty-four hours later there were twelve confirmed deaths. People panicked, and families gathered a few belongings and headed down the road toward Lexington. Two days later, Maysville seemed deserted: the shops were closed; the newspaper stopped publishing; riverboat crews refused to stop at the landing. For two weeks, the town was nearly empty, and by mid-June sixty people had died. The refugees from Maysville took the disease with them, and one could follow it on the map. When cases were reported in Flemings-burg, almost the entire population fled; there was panic in Richmond, Winchester, and Mt. Sterling and at popular resorts at Blue Lick and Har-rodsburg, where refugees gathered for safety. Four percent of Cynthiana's residents died, as did 7 percent of the people of Paris.¹⁸

As cholera moved toward Lexington, city residents confidently expected to be spared; after all, wrote Nancy D. Baird, Lexington was known as the healthiest city in Kentucky. Physicians predicted that, since the streets were clean, bad air was unlikely to form. A newspaper editor for the Lexington Observer advised people that, if they cleaned their homes and avoided excessive drinking, they would be safe. Mayor Charlton Hunt, son of John Wesley Hunt, and the city council published a broadside recommending a bland diet and avoidance of fatigue and exposure to night air. The document included a section on suggested preventive medical treatment written by an anonymous physician, probably Dr. John Esten Cooke. The doctor recommended that, for the treatment of upset stomach or loss of appetite, people take “Cooke's Pills” and that, on the first appearance of diarrhea, they “take thirty grains of Calomel at once” and thirty-grain doses every twelve hours until bowel discharges became green or black. If looseness increased, doubling the dose “at once” was advised.¹⁹

It was not known at the time that Asiatic cholera was caused by the bacterium Vibrio comma, which spread on the unwashed hands of the infected, on uncooked fruits and vegetables handled by unwashed hands, and, more significantly, in bowel discharges of infected patients that contaminated the water supply. As mentioned, symptoms began suddenly and without warning with diarrhea, vomiting, and severe cramping. Dehydration led to oxygen deficiency in the skin; the face turned blue, and the hands and feet looked puckered and felt cold. Some died within a few hours, and most who died expired within twenty-four to thirty-six hours—the death rate was about 50 percent. The nightmare of this killer creeping toward a town was caused when infected travelers or refugees brought the disease to the area and contaminated the water supply with fecal matter carrying the bacteria.²⁰

Lexington and Fayette County were proud of their outdoor privies because many never required cleaning—the waste seeped into the limestone shelf beneath the surface and drained away into underground sinkholes and caverns. Generally, there was no health problem, but, after heavy rains, human waste could be washed into the streams supplying water to wells used for drinking water. Cholera first appeared in Lexington in 1833 on June 2, five days after it began in Maysville. It started with only a few cases among residents on Water Street, and people expected only a few cases, the same as the previous year. But, on June 3, a rainstorm flooded Town Branch, spilling out into the streets, wells, and privies. After that, the disease spread from Water Street to present-day High Street and throughout downtown. Another rainstorm occurred on June 7, and deaths increased to fifty a day. Many panicked, and within a few days about two thousand of the six thousand residents fled to spas, such as Olympian Springs, and homes of friends and relatives in rural areas. Factories and businesses closed, including the normally bustling Market House; only a few brave farmers brought fresh vegetables into the stricken city. Eyewitnesses said that the only sounds were the infrequent footsteps of a neighbor going to fetch the doctor or calomel from the pharmacy. When the outbreak ended in early August, five hundred people had died in Lexington.²¹

In spite of the rainstorms that filled wells with water, apparently no evidence has been found to indicate that residents of Fayette County at that time had any suspicion that cholera was caused by germs in the water supply. Dr. Cooke published an article in the Transylvania Journal of Medicine and Associate Sciences suggesting that it was caused by hot or cold temperatures and miasmata, an unknown agent contaminating the air. Dr. Daniel Drake, who had moved to Cincinnati and had established the Medical College of Ohio, the present-day University of Cincinnati College of Medicine, wrote that cholera was caused by tiny animals but admitted that he could not prove it. Dr. Cooke's former student in Barbourville, Dr. Samuel F. Miller, wrote in his Transylvania University M.D. dissertation that people around Barbourville contracted cholera when they breathed swamp gas rising from marshy areas along the Cumberland River. Medical scientists simply had not discovered bacteria, and it was ironic that the center of scientific research and advance, Paris, France, was struck very hard by cholera and the French Clinical School also lacked any explanation.²²

The general belief that the disease could be contracted by contact with the infected and that contact with the dead was even more dangerous led to great acts of compassion and courage by some Kentuckians. During the outbreak in Louisville in 1832, the board of health requested that the Sisters of Charity provide nursing care. Sister Catherine Spalding asked for volunteers among the sisters at Presentation Academy in Louisville. Catherine and her fellow nuns at the academy volunteered, and four more volunteered from the Sisters of Charity home at Nazareth near Bardstown. The sisters from Louisville who volunteered were courageous because they went into homes in the poor neighborhoods, where bad air was believed to be more prevalent. But the four sisters who came from Bardstown were even more heroic—they came from a town with few cases into more infected Louisville. None of the Sisters of Charity died in the 1832 contagion, but in 1833 cholera struck hard in Bardstown; ten sisters had cholera, and three died. Catholic bishop Benedict Joseph Flaget, “the First Bishop of the West,” had the disease, and, after three days in serious condition, he fully recovered.²³

In Lexington in 1833, all the physicians bravely remained in the city and worked tirelessly to provide treatment. Three of the doctors died, and three courageous physicians came from Louisville to fill the gap; other doctors in Louisville volunteered to come if needed. Protestant and Catholic pastors and theology students from Transylvania University went into homes to care for the sick, and they buried many of the dead. But so many fatalities occurred so quickly and there was so much fear of dead bodies that bodies stacked up outside Lexington Cemetery, many dressed in the nightclothes and gowns in which they expired. Workers dug long trenches for common graves, and William “King” Solomon, who volunteered to bury the dead, earned the fame that made him the subject of Samuel Price's painting.²⁴

In 1833, Louisville had only between 15 and 20 deaths, all transients who seemed to have contracted the disease elsewhere. Louisville residents assumed that bad air was not present and that there was no danger. Versailles and Nicholasville escaped, and only a few died in Frankfort, but over 100 died in Franklin County. Lancaster had 116 deaths, Somerset 34, Danville 55. In the spring of1834, cholera moved into Bowling Green, Glasgow, and Greensburg, and, in summer 1835, 147 persons died in Russellville, where every store closed and most of the healthy people fled. “I have never seen such a scene of calamity in my life,” wrote Rebecca Washington. In 1849, by June 13, Lexington had 98 deaths, about 60 of them in the Eastern Kentucky Lunatic Asylum. Authorities fired a cannon on the asylum grounds, hoping the smoke would purify the air of the miasma believed to be causing the illness. Henry and Lucretia Clay were infected and recovered, but John Wesley Hunt died with symptoms of the disease on August 21, 1849, at the age of seventy-six.²⁵

Before the discovery of bacteria, medical theorists were wandering in the dark, walking in circles, and sometimes heading in the wrong direction. For several decades into the 1840s, the group of scientists on the cutting edge of progress were the French clinical pathologists who dissected the bodies of patients who died from disease. Tradition dating back to ancient Greece said that congestion in the liver or an abnormal liver caused illness. Postmortems of cholera patients revealed that their livers were frequently congested and enlarged. This strengthened the belief that large doses of calomel were needed to stimulate the flow of bile. Thus, postmortems of cholera patients contributed to the use of calomel into the twentieth century.²⁶

Rush's heroic theory dominated American medicine until about 1850, before it was finally moderated. By midcentury, the practice of bleeding was declining, and, mercifully for all the Civil War soldiers who were sick, it was almost completely discontinued by 1860. By the Civil War, blistering by burning the skin with chemicals or a burning string was gone. The traditional interpretation is that, by 1850, physicians had developed greater confidence in nature, in the ability of the body to heal itself, and that, therefore, they practiced milder and less intrusive therapies. Medical historian Charles Rosenberg claims that they saw the light, not voluntarily, but only because they were forced to change to stay in practice. Physicians, Rosenberg wrote, moderated their treatment in reaction to the tremendous attack on them by sectarian doctors such as the Thomsonians, homeopaths, and hydropaths, who condemned heroic therapy and recommended milder treatments. Indeed, this assault from doctors espousing alternative medicine was the driving force behind the organization of the American Medical Association in 1847. Rosenberg points out that, even though the sectarians rejected heroic treatment, they nevertheless adopted the same central body metaphor; they just insisted that balance be restored more by nature and with their own mild treatments of elimination of matter from the body. People using home remedies used the metaphor as well, and it continued in use in some families in Kentucky into the 1940s, where the first home remedy for every illness was a tablespoon of castor oil. Rosenberg wrote that the other main reason for the change was that prosperous upper-class clients of the doctors demanded milder treatments.²⁷

Medical historians generally have assumed that calomel for purging and tartar emetic for induced vomiting were dropped by about 1850 or at least used less. In Civil War Pharmacy, however, Michael Flannery revealed that American physicians continued prescribing calomel and tartar emetic into the 1920s. Flannery discussed how talented and efficient Union surgeon general William A. Hammond was fired in August 1864 because in 1863 he had incurred the wrath of the nation's regular doctors by removing calomel and tartar emetic from the list of drugs supplied. His circular of May 4, 1863, stated that modern pathology proved that calomel did not cure diseases and that used in excess, as Rush had recommended, it caused “profuse salivation” and “mercurial gangrene.” Hammond was removed for practicing solid scientific medicine over fifty years ahead of his time.²⁸

During the second quarter of the nineteenth century, Transylvania University continued its emphasis on medicine and science. When the main building burned on May 9, 1829, it was a crisis because the institution was still adjusting to Holley's departure. The board of trustees elected a building committee chaired by John Wesley Hunt, who secured a contract with Gideon Shryock. Applying the Greek Revival style, he modeled the portico of the building after the Greek Temple of Theseus; it was expensive, but Henry Clay came to the rescue. As a skilled attorney, he cleared the title of the school to the legacy in the will of James Morrison that had been tied up in litigation for six years since Morrison's death in 1823. Morrison had been a pioneer merchant, president of the Lexington branch of the Second Bank of the United States, and chairman of the board of trustees at Transylvania; he was well read and loved higher education and the school. The building was completed in 1833 and designated Morrison College until the twentieth century, when it became known as “Old Morrison,” which it is affectionately called today.²⁹

The Academic Department was saved, but it struggled in the 1830s from frequent changes in the university presidency. Nevertheless, the law and medical schools continued growing in strength and student enrollment. The law faculty continued educating prominent lawyers, including Supreme Court justice John Marshall Harlan, who graduated in the class of 1852. The Medical Department was still the pride of Lexington and still had its high reputation nationally when three faculty members—Charles Caldwell, John Esten Cooke, and Lunsford P. Yandell—left to teach in the new, second medical school in Louisville. In hindsight, it is clear that one of the most significant long-term contributions of Lexington and Transylvania to science and medicine was the creation of the Louisville Medical Institute in 1837. At the time, the competition for enrollment symbolized the rivalry between Lexington and Louisville for dominance of the state's commercial, industrial, and cultural life. With the rise of the steamboat era and river commerce, Louisville had moved ahead and in 1830 had over ten thousand people, overtaking Lexington for the first time. There was a spirit of buoyancy and growth in the air in Louisville; new buildings were going up, and the symbol of confidence in the future was the successful 1830 opening of the Louisville and Portland Canal around the Falls of the Ohio—Kentucky's only canal in the great boom era of canal building. Louisville established a school system in 1829, the first city school system west of the Allegheny Mountains. There was a literary society, and in 1828 a theater opened on Jefferson Street. Lexington was still the cultural center of the state, but it was losing to Louisville in business expansion and population growth.³⁰

Transylvania University was the number one laurel of Lexington as the Athens of the West, and the Medical Department was the shining star of the school. Therefore, many people in Lexington felt betrayed when rumors circulated that the medical faculty was moving to Louisville. When a Lexington newspaper accused Louisville of stealing Lexington's institutions, a Louisville editor responded that Louisville had no intention of taking the lunatic asylum; Lexington would need it for its leaders “in their old age.” The rumors were based on fact—the medical faculty discussed the move in a meeting in 1836, and, when an investigation by the board of trustees in March 1837 confirmed that some faculty members were involved, the board temporarily dismissed the entire faculty. The Louisville City Council quickly purchased land, appropriated thirty thousand dollars for a building, and offered to hire the entire Transylvania medical school faculty. After Caldwell, Yandell, and Cooke accepted, the Louisville Medical Institute opened in October 1837. Besides the momentum of expansion, Louisville had the advantages of access to steamboat travel, more cadavers for dissection, and the thriving Louisville Marine Hospital for clinical instruction. Transylvania students had treated patients at the Eastern Kentucky Lunatic Asylum in Lexington since it opened in 1824, but Lexington had no hospital for clinical training.³¹

Lexington rallied in September 1838 with the creation of Transylvania Institute, a friends organization of one hundred men who elected Henry Clay as their president and pledged to donate one hundred dollars a year for five years to Morrison College, the formal name of the Academic Department, and other charitable and literary organizations. Inspired by this, in spring 1839, the Lexington City Council appropriated to Transylvania seventy thousand dollars: twenty thousand to Morrison College, five thousand for books for the Law Department, and forty-five thousand to the Medical Department (fifteen thousand for apparatus and books and thirty thousand for a new medical building). This appropriation kept Lexington in the competition by providing funding for the new building to counter the new building in Louisville. The medical faculty purchased land on the corner of Second Street and Broadway, and the cornerstone was laid in July 1839. The attractive structure, finished in 1840, included a museum, a library, and five dissecting rooms, and it opened with national publicity that also mentioned the purchase of new books and new equipment in Europe in 1839. For now, Lexington had saved its medical school, and enrollment increased and remained high for another ten years. The result of the Louisville-Lexington rivalry was that Kentucky had two growing, very high-quality medical schools that contributed to science education.³²

The year 1840 marks the height of Kentucky educational accomplishment in the antebellum period. In this year, the state had 10 colleges, 116 academies and grammar schools, and 952 primary or common schools. Kentucky's 116 private academies compared to 73 in Ohio. It was outstanding that Kentucky had ten colleges, which was a greater number than Indiana, Illinois, Tennessee, or Missouri. Perhaps a barometer of the interest in science in the state is Bacon College, organized in 1837 in Georgetown, Kentucky, and named for Francis Bacon, the English champion of the experimental method. Bacon College purchased the $6,699 collection of instruments that had been obtained in Paris and London by the Kentucky Female Eclectic Institute, which had opened near Frankfort, Kentucky, in 1832.³³

Transylvania's Medical Department soon reached the zenith of success in its history. After Rafinesque, the greatest general science teacher in Kentucky in the first half of the nineteenth century was Dr. Robert Peter—who bridged the divide between the Academic Department and the better-supported Medical Department by teaching in both. He was an accomplished physician, but his first love was teaching science. He was born in England and came to the United States with his parents at about the age of twelve. The family settled in Baltimore and then Pittsburgh, where Peter was apprenticed to a pharmacist. He attended the Rensselaer Institute Scientific School in Troy, New York, and came to Lexington in 1832 to teach chemistry and geology at the Lexington Eclectic Institute, organized by Benjamin O. Peers in 1830. Peter approved of Peers's emphasis on laboratory instruction. The Eclectic Institute struggled, however, and, after it closed, Peter worked at Transylvania as an assistant to the chemistry professor in the Medical Department and enrolled as a medical student, eventually earning an M.D. degree in 1843. In 1833, he was appointed the chair of chemistry in the Academic Department, and, in 1838, he was also appointed chair of chemistry and pharmacy in the Medical Department. From 1841 to 1857, he continued teaching and served as dean of the faculty.³⁴

Peter believed in the experimental method and was an early advocate of teaching science in the laboratory to undergraduate students. He wanted students to observe chemical reactions firsthand and to learn about the properties of matter. In Europe, laboratory teaching became accepted in the 1780s and was well established by the 1820s in German universities. Peter's approach was in advance of science teaching in England, where in the 1840s laboratory instruction was used in trade schools but not yet considered part of university education. Later, in the 1860s, English professors began teaching science in laboratories, and it was well accepted there by the 1880s.³⁵

Peter used his position in the Medical Department to borrow laboratory equipment to teach undergraduates; otherwise, laboratory teaching in the Academic Department would have been second-rate. In 1839, having been teaching one year in the Medical Department, he acted to update the library and equipment by going on a buying expedition. He and Dr. James Bush, professor of anatomy and surgery and a protege of Dudley's, went to Europe to purchase eleven thousand dollars worth of books, anatomical models, and apparatus, including instruments such as a hygrometer, bought in Paris, to measure humidity in the air. The hygrometer and other instruments enabled instructors to demonstrate the basic laws of physics. The two Kentucky professors consulted medical teachers in Philadelphia on the outbound trip and then met with leaders of the profession in Paris and London. They visited medical schools and attended lectures, and, from Paris, Peter wrote his wife that none of the surgeons he had met in London or Paris were as eminent as Dudley. From London he told her that with the new purchases “Transylvania will shine. No other institution in our part of the world will be able to compare with her in the means of instruction.”³⁶

Peter used the new chemical apparatus of the Medical Department, equipment acquired by the university earlier, and his own private laboratory apparatus to teach undergraduates. He would open chemistry class by declaring that the course was to be strictly experimental and practical. “Each member of the class,” he said, “if he wishes, will have the privilege of handling, examining and experimenting for himself, experience having demonstrated that this is the only method of acquiring a thorough knowledge of this science.” Peter had a major role in enabling the Transylvania Medical Department to reach its highest enrollment ever in the 1841-1842 session—271 students.³⁷

At the same time, medical education was also flourishing in Louisville. The Louisville Journal declared: “Louisville may be proud of her Medical School, which is dispensing the benefits of a benign profession over all the States, and villages, and hamlets of the west, and has given her a name among the cities in which science and learning find a home and encouragement.” The Journal's editor, George Prentice, was proud that the Louisville Medical Institute attracted students from ten states outside Kentucky, including Illinois and Ohio. In his valedictory address to the graduates of the third session on March 10, 1840, Dr. Daniel Drake said that, together, the two Kentucky medical schools had a total of 460 students, making Kentucky second only to Pennsylvania in the number of medical students. But the great question Drake asked that day was, “Can Louisville hope to overtake Lexington, the ancient seat of Western Medical education?”³⁸

The Louisville school also employed Gideon Shryock as the architect for its medical building, and he designed an even more elaborate brick, three-story Greek Revival structure. The crowning feature was a beautiful skylight-cupola designed to furnish natural light for the first large medical amphitheater in the West. The building had four dissection rooms, a library, and a museum with anatomical models and paintings for obstetrical instruction. Twice each week, students walked the wards of the Louisville Marine Hospital for clinical instruction. The Louisville school had Dr. Samuel D. Gross as its professor of surgery. He was one of the most nationally acclaimed surgeons of his day and the successor to McDowell and Dudley as the most outstanding surgeon in Kentucky. He earned an M.D. degree from Jefferson Medical College in Philadelphia and came to Louisville in 1840 from Cincinnati, where he published the respected book Elements of Pathological Anatomy in 1839. Like McDowell and Dudley, he emphasized cleanliness rather than speed. He taught that some unknown pathogen transmitted infection from the surgeon's hands and instruments unless they were clean. Gross was one of the first in Kentucky to recognize and teach the value of ether and chloroform. He reported in 1852 to the Kentucky State Medical Society that Kentucky surgeons ranked as high as any in the nation “in originality of conception and boldness of execution.” After sixteen years in Louisville, he went to Philadelphia to teach, and in 1879 the state medical society invited him to speak at the dedication of the McDowell monument in Danville. The master of ceremonies introduced him as “the greatest of living surgeons in America” and presented him McDowell's door knocker. He remarked: “The years of my life which I passed in Kentucky represent the most important era in my career.”³⁹

Meanwhile in Lexington, even though the Medical and Law departments were strong, the Academic Department was struggling to remain open. In 1841, it had only twenty-five students and two faculty members. At that point, the trustees attempted to strengthen the department by handing it over to the Methodist Episcopal Church of Kentucky. At the time, this appeared to be the road to success as other Kentucky colleges, such as Presbyterian Centre College and Baptist Georgetown College, were prospering with denominational support. At first, the change seemed successful because in the 1843-44 academic year the Academic Department increased twenty-eight students over the previous year to 278. Kentuckians followed the rivalry, and soon it became clear that the Lexington medical school was falling behind. A Transylvania medical school alumnus wrote a letter to the editor of the Lexington Inquirer pointing out that at Transylvania one professor taught both anatomy and surgery whereas the subjects were taught by separate professors in Louisville. Unless additional medical faculty were hired, he wrote, Transylvania's medical school was headed for “dissolution and abandonment.” By 1847, Transylvania's medical school lost momentum, and, by 1850, competition from Louisville and from the medical school in Cincinnati was overwhelming.⁴⁰

By 1861, the two medical schools in Kentucky had graduated 3,381 regular or allopathic (conventional or orthodox) physicians, and many practiced in Kentucky. They so dominated state medical practice that rivals in the national botanico-medical movement were never able to gain a foothold in the commonwealth. The botanico-medical doctors, such as physio-medicals (a splinter group from the Thomsonians launched by Alva Curtis), Thomsonians, and eclectics offered alternatives to the allopaths from medical schools. These medical sects accepted the same central body metaphor as the regulars, but they excluded bleeding and mercury as treatments for restoring balance in the human body. Homeopathic physicians, another sectarian medical group, excluded these too but were distinct from the botanics while at the same time presenting themselves equally contentious in promoting their system of healing. They followed the theory of German physician Samuel Christian Hahnemann that an infinitesimal dose of drug that produced the symptoms of a disease in a healthy patient would cure that illness in a person who was sick. Thomsonians followed the principles of New Hampshire medical practitioner Samuel Thomson, who treated patients with steam baths and botanical remedies such as lobelia, the weed called Indian tobacco. Eclectics stressed botanical remedies as well and emphasized that whatever remedy proved effective as an alternative to the heroic medicine of the regulars should be used. Medical historian Michael Flannery discovered that the alternative doctors were never significant in Kentucky; few practiced here. “No sectarian group could compete with such a tremendous and continuous output of allopathic physicians,” Flannery wrote.⁴¹

Another legacy of Kentucky physicians is the unusually good health of Kentucky men enrolled in the Union army. Historian John David Smith analyzed the records of over thirty-eight thousand Kentuckians examined in the last two years of the Civil War for the physical and mental ability to perform military service. He concluded that they were quite healthy. The men were draftees, volunteers, and substitutes between twenty and forty-five years of age, the age range of Union conscription. All eight of the examining physicians rated white Kentucky recruits as superior, natural soldiers. One of the physicians reported that they were “athletic and muscular” and generally had good eyesight, good teeth, and sound mental health compared to men examined from other states. Seven of the eight doctors also praised the health, physical qualities, and attitude of the Kentucky African American men they examined. They were as “well calculated to make as good a soldier as ever marched to the field of battle,” brave, and determined with “the greatest physical aptitude for military service.”⁴²

Kentucky was in the forefront of medical and scientific advances and instruction in the first half of the nineteenth century. Parents in other western states and in several Atlantic states gave Kentucky a high commendation by sending their sons to study medicine, law, and other subjects at Kentucky universities. Medical education at Transylvania University and the University of Louisville was high quality, with up-to-date laboratory instruction and the benefit of excellent libraries with books and journals from Paris and London. Through the early 1840s, Kentucky's medical professors, surgeons, and general practitioners remained on the leading edge of innovation, particularly with smallpox vaccination, the use of anesthesia in surgery, and the treatment of fevers with quinine. Research in Kentucky contributed to significant advances in medical botany. Transylvania University president Horace Holley was ahead of his time with his vision of a nonsectarian state university emphasizing medicine and science and public engagement that included some science classes that welcomed women and men from the community who were not enrolled as regular students. Many Kentuckians supported Holley's dream, and many enthusiastically supported university science teaching. Transylvania University science professors Constantine Rafinesque and Robert Peter were so advanced in learner-centered instruction that they would be at home in the classroom today. Three Kentucky surgeons—Ephraim McDowell, Benjamin Dudley, and Samuel Gross—were among the most educated and innovative in the world, and all three foreshadowed modern asepsis with their emphasis on cleanliness in the operating environment. During the Holley era, Transylvania University's Medical Department placed Kentucky in the forefront of medical education.

Then, American medical education experienced a very volatile time of proliferating proprietary medical schools more interested in profit than in meaningful standards. Between 1840 and 1877, forty-seven new medical colleges were opened, and, competing desperately for students, they reduced fees and lowered requirements; several institutions offered a degree for only a few weeks of attendance. In order to survive, medical school professors often taught at more than one college. Transylvania University's medical faculty sought this remedy for a few years by organizing the Kentucky School of Medicine in Louisville in 1850. It was a private school, and Transylvania University professors invested their own money in the new school and taught in both institutions. The two schools cooperated by offering back-to-back sessions that enabled students to earn a degree within twelve months. The arrangement failed to stop the declining enrollment in the Medical Department at Transylvania, and the department closed in 1859. The Kentucky School of Medicine and the Medical Department at the University of Louisville also suffered declining enrollments in the 1850s. At the University of Louisville, medical professors taught double course loads and began offering summer classes. Both institutions struggled through the Civil War but managed to survive. The war was devastating for education on all levels and destructive to the optimistic, forward-looking spirit of Kentucky.⁴³