PHILADELPHIA COUNTY MEDICAL SOCIETY.
February 12, 1850.
President Dr. S. Jackson (late of Northumberland) in the Chair.
The subject of oil of turpentine which has been proposed for
discussion this evening, was introduced by the President with a
few observations which he has since extended and multiplied as
follows:
The subject proposed for discussion this evening is, the use of
oil of turpentine in typhus fever, (including what has been called
the typhoid,) in puerperal and yellow fever, in dysentery, and in
hemorrhagies, particularly those that occur in these various diseases.
In all these there would appear to be one general state of the
whole system, that of fever with inirritability, requiring more or
less stimulation ; and happy it is, if physicians have found in
turpentine, a stimulus of peculiar operation exactly suited thereto.
The use of this article in these diseases, has been discovered
within the present half century, and it now appears to be gain-
ing upon the profession both in Europe and America ; hence it
may be well for each of us to adduce what he has read and done,
thus throwing his mite of latent knowledge into a common stock,
for the common benefit of all and for public profit.
The terebinthinate medicines, though much used by our fore-
fathers, esteemed and called by them the balsam or balm of the
viscera, fell into such neglect that many systematic authors barely
mentioned them for a long series of years. Thus the Die. des
Scien. Med., the volume containing this article published in 1821,
gives but a meagre account of them and says—“ they are much
less used than formerly.” The Die. de Med. 2nd edition, vol. 29,
published in 1844, has very little to say concerning them, and not
one word on their use in hemorrhage or fevers, except a mere
passing hint that the oil had been given in puerperal fever. Nor
does this comprehensive work advert to them under the head of
typhus or of dothinenteritis. Cullen, Eberle, and Paris, speak of
the oil in their works on Materia Medica, as a diffusible stimulus,
but say nothing of its use in low fevers, dysentery, or hemorrhage;
nor do Good, Watson, Gregory, Eberle, McIntosh, Dunglison,
name this article in relation to these diseases in their systems of
practice, except that Good admits it in chronic dysentery, and
Watson merely mentions it for melsena, as a thing he had heard of.
Southwood Smith says nothing of its use in typhus fever, even
when there was abdominal pain and flatulence. He once men-
tions it in hemorrhagic fever :—“ now and then he says, a
stimulant has a greater effect in checking hemorrhage than an
astringent, and then the ol. tereb. is the best remedy.” Burne
who published an excellent monograph on adynamic fever in
1828, does not name turpentine, though he says much on the
tympanitic abdomen, ulcerated bowels, and hemorrhage in this
fever. Wilson Philip on fevers, and our own Nathan Smith on
typhus, are wholly silent ; so is Bartlett, even in his 2nd edition,
a work wherein he certainly wished to comprehend all good things.
The Library of Pract. Med. gives not a hint concerning its use in
hemorrhage, whether active or passive, except in melaena ; nor
yet in dysentery or fever except the puerperal, and yet Dr.
Dunglison has contributed his share, and filled up the supposed
deficiencies of the great salmagundi.
Although the utility of oil of turpentine in these diseases, is a
late invention, there has been ample time to bring it into more
general use : and we can hardly excuse the silence of so many
writers on a subject of vital importance with which they ought to
have been thoroughly acquainted, for Dr. Chapman in his Thera-
peutics published in 1817, has written much that goes directly
to our present purpose. Now when it is remembered that he had
then been lecturing to large classes for four years, the knowledge
we refer to, must have been widely diffused.
But Dr. Rush in his history of the yellow fever of Philadelphia
in 1805, says that Dr. Physick used it that year with success for
the vomiting that occurs in the second stage. It does not appear
that he used it in the fully formed black vomit, but merely in that
exhausted state of the whole system, and particularly of the sto-
mach, which soon brings on this fatal symptom.
Dr. Brennan, a wild and eccentric physician of Dublin, brought
the oil into use in puerperal fever in the year 1814, with undoubted
success: his method has since been cried up by some and cried
down by others, and as always happens in such cases, without a
due regard to the state of the system, and to that peculiarity of
action which a remedy may exclusively possess, without our even
suspecting it; which, moreover, cannot be ascertained with cer-
tainty without a long continued empiricism, scientifically, or at
least artfully conducted.
In the London Medical and Physical Journal for 1821, Dr. Cop-
land published a paper on the virtues of turpentine, and this was
transferred to volume second of the Journal of Foreign Medical
Science, published in Philadelphia, and read beyond the mountains
of Pennsylvania in 1822. The author commends it in common
dysentery and some hemorrhages, all which is directly to our pre-
sent purpose ; but he details so many other diseases which he cures
therewith, as to bring upon himself some slight imputation of
quackery. He does not, however, advocate its indiscriminate use
in all states of the system. He says—“ a phlogistic temperament,
though the debility be very considerable, ought to forbid its use.
The best general indications for the internal employment of this
remedy in hemorrhagic diseases, and those by which I have been
guided, are the absence of plethora and the phlogistic diathesis;
when there has been a previous great loss of blood ; when the
pulse is soft, weak and easily compressed, indicating a want of
tone in the arterial system. In a word, it can be used in all
hemorrhages of a truly passive character.” We shall see after a
few pages, that he became more bold by practice, and that both
he and his New York editor, use the medicine now without regard
to the states active and passive.
Dr. Chapman was probably the first to bring the medicine fairly
before the American physicians in the treatment of fevers and
hemorrhagies; for as said above, he both published and lectured
on the subject in the year 1817. In his Therapeutics first pub-
lished this year, he recommends from his own experience, the oil
in typhus fevers, when stimuli are called for and in the summer
fevers with what he calls a typhoid tendency. He then notices
Physic’s use of it in the vomiting of yellow fever in 1805. In
subsequent editions, I quote from the fifth, he speaks of its great
utility in this disease as it stood in 1820, when he and Dr. Hew-
son gave the oil not merely for the vomiting but as a specific
against the whole malady. “ Of. the counter agency, says the
professor, of turpentine in scalds and burns, we are aware. The
stomach in yellow fever, is in a state of inflammation, probably of
a somew’hat similar nature, which is overcome in the same way.
This conjecture derives support from the consideration that, in
many instances, the turpentine is soothing in its effects, removing
the sense of heat and irritation in that viscus, subduing the force
of vascular action and general excitement, and inducing at once a
condition of more comfort and security.”
He and Dr. Hewson under whose care the hospital at Bush-hill
was placed, gave the oil, a drachm every hour, to sixteen patients
of whom twelve were cured. “ Compared, says the Dr., with
what was done in the city by other modes of treatment, this suc-
cess was exceedingly encouraging. It should too be recollected,
that most of the patients were brought into the hospital in an ad-
vanced stage of the disease, much reduced by venesection and other
evacuations.” He then says in a most unfortunate lapsus ingenii,
that “ unless it be employed at the commencement or very early in
the attack, the turpentine in common with all remedies, will be
for the most part unavailing.” Yet twelve out of sixteen cases
were cured though in “ the advanced stage and much reduced by
venesection and other evacuations to which you may add the
agitation of jolting them two or more miles to Bush-hill, after such
medical debilitation and that of the disease conjoined. I would
rather take the doctor’s fact than his opinion, and say that tur-
pentine cured twelve of sixteen deplorable cases.
The professor reasons wrell on its mode of operation, as far as
human reason can go by analogy. But we must take the facts
which are sufficient of themselves and there is no need of theo-
rising unless as a means of persuading the incredulous. Hrs. Phy-
sick and Chapman’s facts are incontrovertible, their reasoning may
not prove conclusive to every mind, hence we shall not detain the
reader therewith.
But, alas for medical experience ! Professor Jackson’s History
of Yellow Fever of 1820, Philada. Med. and Ph. Jour. Vol. II.
11-16, says, the medicine proved less highly beneficial in the city
as used by other physicians, and this fact he imputes to the
“ effects produced by a pure and salubrious air at the hospital,
constant medical attention, and good and faithful nursing.” All
these are good and useful things, but experience has proven, that
they will not, when used without turpentine, cure twelve of six-
teen such patients as Dr. Chapman describes. Rather than yield
my cheering opinions of Dr. Chapman and Hewson’s success,
I would consider Dr. Jackson’s patients or those of whom he
speaks, as among the incurables, in consideration of whom he
says p. 17, “ there is a limit placed beyond which no human effort
can extend and where human skill and art cease to avail.”
Dr. Charles Caldwell in his history of the yellow fever of 1805,
appended to his translation of Alibert, says—“ other practitioners
derived much advantage in cases of obstinate vomiting, from the
use of spirits of turpentine, a remedy first proposed by Dr. Physick.
The Dr. appears to have taken the hint in this instance, from the
efficacy of that article in preventing gangrene from severe burns.
His object was to prevent black vomit and death of the stomach
from excessive inflammation. I am sorry to add, that in my
hands, that remedy was not productive of those happy effects
which are said to have attended its use in the practice of other
physicians.” Here the Dr. is one against many according to his
own account; a strong man certainly, but the battle is not always
to the strong. A fortuitous concourse of untoward circumstances,
often perverts for a time, the brightest minds in medicine.
Professor Wood in the year 1826, published in the North Amer.
Med. and Surg. Jour. vol. i. a paper on the use of the oil in re-
mittent and in typhous fevers. He seems to limit its use to a cer-
tain state which appears to be mediate or transitive to either life
or death, as nature may adjudge the case, to use an idea of the
ancients ; for this is their true crisis, when nature sits in judg-
ment, and the patient is ready to go either way. The tongue,
after having become moist and begun to clean itself—thus afford-
ing indications of a speedy recovery—suddenly becomes dry,
smooth, and red ; the abdomen becomes tender and distended ; the
stools dark and offensive ; the urine high colored ; the skin dry
and harsh; the pulse more feeble and frequent; the intellect
wanders and the countenance expresses anxiety and suffering.*
* With respect to this delusive cleaning of the tongue, Dr. Rush says,
“We sometimes see the tongue after being dry in this fever, suddenly
become moist; and yet the patient sinks under the disease.”—Rusli’s
Pringle, p. 262 note.
Here the professor considers the oil as an almost infallible re-
medy in a state of things which no other stimulus has been found
to relieve. To this proposition we assent most cheerfully. I do
not remember having used turpentine in such cases, but I recollect
having lost such patients under common stimuli before turpentine
came into use. It was a state that I learned to dread, a state on
the very confines of death, and alas for the patient if nature or the
physician make a single blunder. But ipsi pauca velim facilem
si preebeat aurem I will venture to say to the learned professor,
that this perilous crisis must be anticipated and prevented by tur-
pentine. I cannot by any means limit the use of it to the period
when the tongue begins to clean, grow smooth, and redden, as a
deceptive prelude to the sinking state. While the tongue is yet
deeply coated it is often red and dry, the teeth foul and uncovered
—“ dentes reteeti,” the whole body with all its functions appear-
ing altogether cachectic—here we may give this medicine w’ithout
waiting for any tendency in the tongue to throw off its coating,
whether this be in typhus or in the protracted state of inflamma-
tory remittent fever, now assuming somewhat of the typhous
livery.
A principal duty of the physician is to prevent diseases from
running into a state of danger. I can remember myself making a
great trepidation about a patient in this very fever, when an old
busy-body said—“ Poh, Doctor, this woman is in no danger, I have
seen worse cases of nervous fever than this.” Well, Mr. B. did
they recover ?	“ Oh no, there was Mr. A. B. C.—they all died.”
I replied, you have said well, they all died, but my wish is to pre-
vent this woman’s running into such a state that she too must die.*
* Upon looking into Professor Wood’s Practice of Med. since the above
was printed, I find that he does recommend the turpentine to be used
earlier than he proposed in his paper in the North Amer. Med. and Surg.
Jour. He says “ should the tongue become dry and the abdominal disten-
sion be undiminished, the oil of turp. will prove an excellent remedy. I
cannot too strongly impress upon the profession the importance of this
remedy.” And half a page further on, he speaks of it as directly useful in
healing the ulcerated ileum. He says too, “ it is not improbable that mer-
cury may serve in some degree to arrest the progress of disease in the
glands of Peyer.”
I would earnestly enjoin the use of the oil very early in typhus
when there is reason, from well known symptoms, to suspect a
lesion of Peyer’s glands ; for I cannot but hope much from its direct
application to the ulcer itself as well as from its reaching it through
the blood. And here, in order to be understood, I must say that I
consider what has been called typhoid as nothing but an acciden-
tal state of typhus. Both states originate unquestionably from the
same contagion or from the same fomes, have the same general symp-
toms, the same accidental lesions: for what difference is there be-
tween an ulcer in Peyer’s glands and an ulcer in the brain, the axil-
lary glands, or the surge, all which are seen in typhus—what differ-
ence between one phlegmonous inflammation and another ? This
lesion, this effect of disease wherever seated, is red blood in serous
vessels, and further than this, no human eyes will ever penetrate.
Some careless man in Ireland rolls up his dirty shirt saturated
with perspiration, and after some weeks, he unrolls it in the steer-
age, thus infecting himself and others, some with typhus and some
with the so called typhoid. Now surely this must be one disease,
for as Dr. Armstrong says on this very subject—we do not gather
grapes from thorns and figs from thistles—when we vaccinate we
do not expect a crop of measles : but when we poison ourselves
with these fomites, we expect a fever with local inflammation in
various parts, which may or may not ulcerate. But I will cease
to argue for the reader knows all and even more than I could say
in consuming an hour which neither he nor I can spare.*
* With respect to the origin of typhous fever, Dr. Rollo relatps a fact
which may be considered conclusive when taken in conjunction with hun-
dreds of others. Eight men of the horse artillery were taken with a suspi-
cious fever, and upon inqq^ry it was found, that their rooms had entirely
different bedding from the rest of the barracks. The hammocks were
rolled up tightly every morning the moment the men rose, and were not
opened till about to be occupied at night; nor had they been aired for more
than two months, owing to a succession of wet weather ; and therefore upon
opening them for examination a very nauseating smell was perceived.
“Here, says Dr. Rollo, an infectious fever evidently arose from the con-
finement of the effluvia of a man’s own person, in a term of about two
months.” See Ilygeia xi. 45. Much to the same purpose may be found,
but particularly in Willan’s Reports p. 255.
Upon the contagiousness of this disease when thus generated, 1
published a paper in the Amer. Jour, of the Med. Scien. for Oct.
1845, which Prof. Wood and Dr. Bartlett have quoted under the
head of typhoid fever. Call it what you please, it was some-
times the typhus mitior ; sometimes the gravior ; the febris lenta
nervosa and the febris putrida maligna of Huxham from beginning
to end and in the same house at the same time. It comes from
fomites of our own making, though Drs. Chapman and Bancroft
have the grace to believe that it came down from heaven at the
beginning of the world, in common W’ith all good things : and Dr.
Bartlett says—■“ our knowledge of its efficient causes, excepting
that of contagion, is very limited and imperfect.” Now I think
the cause is as manifest as that of drunkenness ; and I would
pledge myself to generate the typhous poison as certainly as a dis-
tiller would engage to make a barrel of brandy.
Well then, in what Mr. Morrison of the Newry fever hospital
calls the cachectic state of typhus and in the long protracted state
of koinomiasmatic fever, I must from much experience maintain,
that the oil of turpentine is a remedy of inestimable value, and
without an equal. Where it was that I first learned the use of this
article in the diseases above referred to, I cannot recollect, but I
clearly remember having used it internally in cholera morbus in
1823, and soon after in typhus fevers, with such success, that it
soon became with me a favorite remedy.
In cholera morbus, when the system appeared to be in a sinking
state, after the puking and purging had been subdued, pulse very
feeble, some fever, coldness of the extremities, listlessness, ten-
dency to stupor—-here this oil in doses of half a dram to a dram
every hour, appeared to be a very important remedy. Whether
I learned this from books, I do not know, for of the farrago of
knowledge now in my head like lumber in a garret, I cannot ren-
der unto every Caesar the things that are his.
With respect to the use of the oil in typhus fever when there is
meteorism, diarrhoea, and therefore a probable inflammation of
Peyer’s glands, it affords a hope which no other stimulus does.
And here I cannot but remark, as I did some years ago in the
Transactions of our College, that although the indications of these
ulcers now existing or impending, appear to be almost infallible,
nothing specific is done to prevent or to cure them. They are not
an inconsiderable item in the history of the disease; for who
knows how soon they may bore through the bowels, so that a
patient who appears to be safe, is really on the verge of a mortal
symptom ? Let us be on the alert and say with Cato—“ vigilando,
agendo, bene consulendo, prospere omnia cedunt.” Hence the pre-
sent writer suggested to the College in his Report on the J'heory and
Practice, Transactions vol. I. 353, that something ought to be done
specifically for these dangerous ulcers and says-—“ blisters have
been found useful excitants and revellents in this disease : we
have found them highly beneficial in cajh attended by hemor-
rhagic diarrhoea, would they not if repeatedly applied to the abdo-
men, derive inflammation from the ileum, particularly if preceded
by cups ? The mortality of this lesion surely requires a specific
interference; we propose then, calomel or bydriodate of potash,
as used by Mr. Morrison ; sp, terebinthinre; cups and frequent
blisters to the abdomen,”	•
When calomel is given in very small, frequent doses, as half a
grain every three hours, it may be managed so as to cure the local
disease without a salivation which is a horrible thing. The
hydriodate of potash possibly acts on the local phlogosis specifi-
cally, as it was found so highly beneficial by Mr. Morrison.
Cups to the abdomem followed by a blister and this kept discharg-
ing pus by means of savin or mezereon cerate, surely promises
much in theory. Pars dolens trahit—there must be a determina-
tion of morbid action from the ileum to the skin, when a steady
and copious efflux of humours is there maintained. Nay, not
merely from the inflamed bowel will the attraction be established,
but from the whole diseased body. Ubi est irritatio ibi fluxus, is
an old motto in such cases; but as there is no pain, no irritation
in a blister thus running with pus., I would rather have a motto
more suited to the fact and say, ubi est fluxus ibi morbus exit.
Or you may say of the disease as Cicero did of Catiline, only
changing the tense, abit, excedit, evadit, erumpit.
With respect to the hydriodate of potash, I will say briefly,
that I was lately called to assist Dr. Neville C. Reid in a case of
the said typhoid fever—such a case as Stahl’s expectation would
not cure, I found the Dr. using the hydriodate in doses of 3 grs.
every two hours, with little else except a well regulated diet. I
encouraged him to go on with the medicine; the fever gradually
wore away, and the patient was restored to sound health. Dr.
Reid tells me that he has used this medicine in several cases with
entire satisfaction.
In the cachectic state of dysentery the very same advantages
are obtained from turpentine ; but here a very different state of
things obtains. In idiopathic fevers, there is something to con-
tend with beside the inflammation, and therefore this stimulus
cannot be used till the phlogistic diathesis be much on the wane ;
but in dysentery, the local disease is paramount; and since this is
concentrated in a mucous membrane and has no tendency to a
translation, and more particularly since the oil seems peculiarly
suited to inflammation of this very organ, it may be given rather
early in the disease. Therefore, though its energy appears most
conspicuous in the cachectic state, it will be found eminently
useful in preventing this state, if given early with all the neces-
sary co-adjuvants.
Nor is it to be neglected as an external remedy. When dili-
gently rubbed on the abdomen, it is soon perceived in the breath
and the urine; and of course it is carried to the diseased mem-
brane. I have thus profited much by it in cases where leeches
and blisters were not thought requisite.
In bringing this subject before the Society, my intention was,
to limit the discussion to its use in that flaccid state of the system,
and particularly of the mucous membrane, in which there is a
great want of excitability and sometimes and in some diseases, a
near approach to a total extinction thereof. This is seen in the
low stages of typhus and remittent fevers, in the same stage of
yellow fever, plague, puerperal fever, and in the hemorrhage
which often attends them, particularly from the bowels. We do
not wait for this low state in dysentery because the general fever
is fast passing off by the bowels, and the undue stimulus of the
turpentine may be carried away therewith.
In the hemorrhage which often attends bilious remittent and
typhus fevers and in melaena, I have had such success as leads me
to consider it an almost indispensable remedy. I certainly did not
rely upon it in bad cases to the exclusion of other potent means,
such as ice, blisters, astringents ; but by trusting to it in the milder
cases and watching its supposed effects in the more severe, I have
carefully formed of it a most favorable opinion. In haemoptysis,
epistaxis, wounds, and other active hemorrhagies, I have never
tried it, but I have been called to cases of all these forms in which
the patients had been using it with apparent advantage.
Dr. Copland in his Diet, appears to recommend it in all he-
morrhagies active, passive, and neutre. He says, “ it constringes
the capillaries of the part to which it is applied,” and “ when
absorbed into the circulation, its astringent effects on the capilla-
ries is very remarkable.” “ When the dose is large, it reduces
the frequency and strength of the heart’s action, especially when
they are much increased, hence it is an appropriate remedy in the
more active forms of hemorrhage, inasmuch as with its astringent
action on the capillaries, it weakens the vis a tergo. “ When
given in smaller doses and carried into the blood, it increases the
tone and changes or modifies the action of the extreme vessels.”
“ The existence of inflammatory action does not contraindicate its
use, for it lowers vascular excitement and prevents effusion and
the formation of coagulable lymph, especially when taken in suf-
ficiently large and repeated doses.” He cautions however against
large doses when the powers of life are much depressed and when
the patient has lost much blood.
Dr. Lee, the New York editor of Copland, says, “ we have
found turpentine one of the most valuable remedies in every form
of hemorrhage. It is rapidly taken into the circulation, as mani-
fested by its odour in the urine and breath, and it exercises plainly
an astringent effect on the capillaries. It posesses moreover the
important effect of operating more promptly than any other astrin-
gent, as we have often observed in hemoptysis which had resisted
other remedies. With proper precautions it may be given both in
the active and passive forms of the disease.”
After such commendations as Copland and Lee’s, one might
suppose there was nothing more to be desired, and yet the praise
is not more extravagant than that of John Hunter. He applied
it to divided arteries and gave it internally in active hemorrhage
as epistaxis and said, “ it was the best if not the only styptic.”
See Braithwaite part xix.—72.
Dr. Chapman commends the oil in hemetemesis, meleena, and in
passive hemoptysis ; then, as though to arrest the attention of the
reader and make upon him an impression not to be forgotten, he
turns his beautiful English wrong end foremost and thunders out
in Ciceronian diction—“ equal proof have I of its use in he-
morrhoids, alike restraining the flow of blood and soothing irrita-
tion.” After such a commendation from such a man, who could
be so criminal as to neglect the experiment ? Surely when this
oil is attainable, no one ought to prescribe sugar of lead which I
know from experience does sometimes bring on its own peculiar
colic, even when given with acetic acid.
Multa desunt: but I have fulfilled in a measure my first propo-
sition—that turpentine was for a long time neglected, and that
when brought into use by some, it was too much neglected
by others; and finally I have advanced some authorities for its
use, which ought to lead on to further inquiries. The reader will
probably say of the present writer as Johnson says of a great poet
—“ Pope in the chair of wisdom tells us much that every man
knows and much that he does not know himself.”