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fuge. It is officinal in the American Materia Medica, and I am told is frequently used by the French Canadian practitioners as a substitute for Quassia.
I brought the matter under the notice of the Medical Society, at the meeting on Wednesday evening; the majority present were French Canadians, who were familiar with the plant, but who had never heard of, or met with any unpleasant consequence from its use. Some of the English practitioners suggested that the child might have been thus affected by the alcohol, but when we consider she was six years of age and in vigorous health, I can scarcely get myself to believe that so small a dose of whiskey, not three drachms, could have produced such complete and protracted insensibility. A medical friend has informed me that he is aware of this fact. A gentleman for a long time connected with the Hudson Bay Company, suffered from the passage of renal calculi and from their passage through the urethra from the bladder. On one occasion his suf. ferings were remarked by an Indian chief with whom he was transacting business; he inquired the cause, and on being told, immediately went out to an adjoining woody swamp and returned with some" Coptis," which he infused, and at once administered, with the result of producing such thorough relaxation, that the urine flowed in such volume as to carry with it a calculus, which was passed without any suffering. Now, it occurs to me, that if the Coptis is capable of producing such complete relaxation as it must have done in this case, that it is quite possible that it may have been the cause of the unpleasant symptoms in the child. Perhaps some of your readers, many of whom I have no doubt are familiar with the "Gold Thread," may be able to afford some light on the subject.
Quebec, 25 St. Geneviève Street, 4th May, 1866.
Case of Exfoliation of Alveolar Process of Lower Juw. By D. MACKIE,
M.D., Assistant Surgeon 7th Royal Fusiliers. The subject of this disease is a bandsman of the Royal Fusiliers; his instrument a trombone. He was admitted into hospital, Feb. 19, with extensive periostitis of the lower jaw, and he attributed the attack to cold he received in his jaw from the metallic mouthpiece of the instrument when playing at one of the rinks on the river a day or two previous. The inflammation for some days was very acute, rendering him quite unable to separate his jaws or to take any solid food. On the 26th the incisors, canines and left bicuspids were evidently loosening, and by
March 3rd, the right canine had fallen out, and there was a considerable purulent discharge from the empty socket. On the 6th a small spiculum of bone was extracted from the socket, while the purulent discharge continued, and at the same time an incision was made at the base of the incisors in front of the jaw, and a quantity of pus evacuated, which had there collected. Next day the left bicuspids, and the first true molar came away, and the discharge from their sockets was considerable. For three weeks after this, the purulent discharge continued from the three places, and many minute fragments of necrosed bone were detached from from the alveoli of left jaw. By the end of the month the exfoliation had ceased, and there was scarcely any discharge. The incisors and left canine still remained very loose; but he was now able to eat some solid food with the left side of his mouth. He was discharged from hospital on 24th April, the jaw having quite healed up, although the front teeth were still very shaky.
In this case there was no history of syphilis, nor of the use of mercury; and before his enlistment he had been employed in a cotton factory, and never had anything to do with phosphorus.
During the time that he was unable to separate his jaws, his diet consisted necessarily of slops ; soup, beef-tea, and such like; and in addition, as soon as the acute symptoms had subsided, wine or porter. As he could not eat potatoes or other vegetables for some weeks, lemon juice was freely given. The antiphlogistic treatment consisted simply of emollient applications and saline purgatives, and the only medicine given after suppuration had commenced, was large doses of Chlorate of Potass, which were continued till the exfoliation had ceased, and the gum had quite healed. After he was able to eat solid food, the lemon juice was omitted; and he was allowed the most generous diet.
NOTE BY DR. ANDERSON.—Having seen this case during its progress, I requested Dr. Mackie to furnish the statement as above; and in
I addition, I shall only remark, that at one time a question arose as to removal of the teeth from the affected part, and I think it was wisely decided to leave it entirely to nature. I believe the front teeth which have been saved, will in time become pretty firm; but if no other end be attained, they will prove very serviceable in speech.
Quebec, 25 Ste. Geneviève Street, 3rd May, 1866.
Medicine. LECTURE ON THE TREATMENT OF CHOLERA, By Deputy Inspector-General Maclean, M.D., Professor of Military Medicine,
at Netley College. I have felt it to be my duty to speak distrustfully of many methods of treating cholera which have lately been urged on the attention of the profession and the public. Many of them, if you will excuse a homely metaphor, are the cast-off clothes of Indian practitioners brushed up to look like new. « Old Indian” doctors know them well, and make a present of them to their new and complacent wearers without a sigh. Well, gentlemen, I know no cure" for cholera. What is more, I suspect we
Ι are never likely to see one. Nevertheless, I believe we shall in time extinguish cholera as we have, in this country at least, extinguished plague. This is one of the certain triumphs that await the slow progress of sanitation. It is probable that a whole generation of obstructives must pass away before even the initiatory steps in this great movement are likely to be taken. We have sanitary commissions in all the great Presidency towns of India ; but they are without the necessary authority to act in an effective way, and, in some instances, very notably in Madras, the whole weight of those in power is exercised to obstruct the efforts of the commissioners for the public weal. We are not very much better off at home. Men ignorant or indifferent in such matters abound in high places, and in almost every municipal body in the kingdom trading selfishness and apathy prevail to the detriment of the public health. It is now time for me to point out what can be done for the benefit of those who are smitten with the disease. Although I know of no cure for cholera, I am quite sure that, by good and judicious management, we can rescue a great many who, without this, would inevitably perish.
1. You will endeavour to secure for your patients the best hygienic conditions possible under the circumstances in which you may be placed. In India, if that be possible, treat your sick in tents, and avoid overcrowding them.*
• Dr. Morehead objects to this, but, as it appears to me, without sufficient
When cholera prevails in an epidemic form, the ordinary hospital accommodation is not enough for our purpose, without exposing the sick from other causes to great discomfort and peril, to say nothing of other
2. It is incumbent on you at the outset of any epidemic visitation to look a little ahead, and so to arrange the duties of your attendants and assistants as not to exhaust their strength and energies in the first few days. I have seen great mischief and confusion result from want of attention to this. The first sufferers who come in under such a system are well cared for; while those who come last are neglected from inability on the part of the attendants to hold out any longer.
3. The next point is to have arrangements made, first, for the disinfection; and, secondly, for the removal of the excretions of the patients. If this be not done, the tents or hospitals, if a large number of patients are under treatment, will soon be filled with bed and body linen saturated with cholera discharges. The attendants, unless prevented, will empty the vessels containing the stools as near to the tents or hospital as they dare. As a disinfectant, Dr. Budd, of Bristol, proposes chloride of zinc; but, whatever the agent, disinfected they should be, and on no account ought the evacuations of the sick to be emptied into the latrines or waterclosets used by the healthy. They should be buried in deep pits strongly charged with disinfecting agents. All soiled linen should in like manner be disinfected, and then plunged into boiling water outside the building or tent. The last case of cholera that occurred in the garrison at Malta, in the late epidemic, was that of a woman who had stolen a chemise, the property of one who died of the disease, She put on this fatal shirt, pro bably soiled with discharges, certainly unwashed, and not many days after the death of its former possessor, took the disease, and died. I mention this instructive fact on the authority of a letter from my friend Inspector. General Anderson, principal medical officer at Malta.
4. The next point is to look well to what Sydenham would have called the "constitution ” of the epidemic with which you have to do. I have never seen any two exactly alike, At one time you will see the majority of the cases characterised by vomiting, excessive purging of rice-water stools, with distressing cramps; at another, you will find cramps absent. Again, you will observe that there is little purging, but excessive action of the skin; or (most fatal form of all) little purging, vomiting, or exudation from the skin, the sufferers dying almost before there is time for any of the well-known symptoms to be developed—the disease, as Magendie expressed it," commencing with death." Nothing can more
“ clearly show how futile it is to expect a cure by merely “restraining the evacuations;" for, as I have just explained, the most fatal form of the disease is that in which there are no evacuations at all.
5. When first I went to India it was a common practice to withhold water, especially cold water, from cholera patients. A cruel and pernicious proceeding. The objection was, that it increased vomiting, and so exhausted the sufferer. Following the routine of the day, I have acted in this way; and I was taught by personal experience the folly of this article of prevailing medical belief. When a person has been drained by an hour or two of rice-water purging, the desire for water is urgentinstinctive: the system craves it as the “hart panteth for the waterbrooks." Do not, then, be guilty of the cruelty of withholding water; give it often, and give it cold. Hot drinks are not relished by cholera patients. There is no necessity to give large draughts; but let not the fact that a portion of almost every supply is vomited lead you to withhold it entirely. If you have a supply of ice at hand, let your patients have as much as they please. I never saw a cholera patient to whom ice was not grateful.
6. Is it a judicious measure to apply heat externally: to cover your patients up with blankets; to stimulate the surface with counter-irritants, mustard, turpentine, and such like? Well, I have done all these things, and seen others do them again and again. Yet I question whether much is gained by them. I am quite sure that they are very distasteful to nine patients out of ten. But you will say, Patients are not good judges of what is good for them. Perhaps not. Still, I think physicians gain something in many diseases by attending to the instinctive promptings of their patients. I know it is so in the matter of drink in cholera ; and I think in the matter of clothing and external heat we should follow this rule—where they are grateful to the patient they should be used, but, according to my judgment, they ought not to be persisted in if the reverse. I have not seen many cases of cholera in England, but I think I have observed greater tolerance of a blanketing" than in India. In Asiatics, the dislike to anything of the kind in this disease is universal. Mustard poultices are almost invariably applied to the epigastrium in cholera, and also to the calves of the legs. Sometimes they are beneficial; I do not think they can be hurtful.
7. Cramps are best relieved by the use of chloroform, given in doses of five or six minims in a little water; and if vomiting be excessive, a little may be sprinkled on a pad of lint covered with oiled silk or gutta percha tissue, and applied to the epigastrium; or spongio piline may be used for the purpose. I have used chloroform in this way, both externally and internally, very freely, and always with good effect. I have also seen a large dose of an alkali, the sesquicarbonate of soda or the bicarbonate of potash, instantly relieve the spasms, as well as mitigate vomiting. 8. No remedy has been more used, I should rather say abused, than
I opium. Most Indian practitioners have abandoned it as treacherous and