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are few in number; and the common duration is from two to three weeks, always excepting those which merge in diarrhea or dysentery, when the end is quite indefinite.
When death is the consequence of cerebral pulmonary, hepatic or intestinal concentration, the reason of its occurrence is intelligible enough; but the majority do not seem to die from these lesions; and the cause of their dissolution is, prima facie, rather obscure. In every ward that I visited, I was surprised at the small amount of visible manifestation of dangerous disease; and, more than once, was prompted to say to the medical gentlemen, “I can't see why so many of your patients die.” In wards from which many corpses were daily carried out, there would be but few who did not look at and after us; put out their moist tongues with faciliiy, and make known their wants; yet many such patients die soon afterwards. Oibers die, when the physician has pronounced them convalescent-others after they have risen and dressed themselves, and crawled into the open air. Such deaths cannot be regarded as the effect of any particular organic lesion, but of a stage of exhaustion or collapse, bearing some resemblance to the third stage of yellow fever, or the recurring chill of a malignant intermittent in the South West; but more, perhaps, to the fatal stage of epidemic cholera.
After this imperfect, but, I believe, not unfasthful sketch of the history of this fever, I must proceed to its cure.
3. It is a maxim with the physicians of Gros Isle and Quebec, that a great amount of medication is inadmissible in this malady. Scarcely a patient is ever brought to them while the fever is still in its forming stage, so that there are but few opportunities of knowing whether art could arrest it in that stage. Once established in the system, the general opinion is that it cannot be cut short. The treatment, then, is merely palliative and corroborative.
By all the physicians, in almost every case, the lancet is repudiated, even when the patients are commanders of ships, and seamen, in whom famine had not preceded the attack. Local bleeding is almost as little employed, the majority of the physicians preferring counter-irritants, when the brain or the lungs are affected.
Emetics are prescribed by some, who speak well of their effects ; but others think they predispose to congestions of the brain. It has not been observed by any that they break up the disease.
All employ cathartics; but the kinds, and the degree of their administration, present considerable variety ; into which, however, I shall not enter, as drastic or long.continued purging is condemned by the whole.
Of sweating I can say nothing, for the patients, generally, are placed under such circumstances as preclude a resort to it.
A standard, or standing, febrifuge mixture, at Gros Isle, as given me by the apothecary, Mr.Barter, is the following :-R. Sod. et pot. tart., Zij.; liq. ammon. acet., 3jss.; spt. ether, nitr., zss.; aque commun., zxij. Misce. Another is composed of the camphorated mixture, tincture of hyoscyamus and tartar emetic.
Some of the medical gentlemen attach but little value to this class of medicines, and rely, during the more acute stages of the fever, chiefly on free dilution; but advise against the addition of acids, as likely to irritate the bowels into diarrhæa.
Opium is not in much favour in any stage of the fever. At a conparatively early period, some physicians commence the administration of wine and aliment, a practice condemned by others, as dangerous to the brain; but all concur in this, that sooner or later, and sometimes quite early, there comes a pathological condition which demands prompt and energetic stimulation. In this resort a choice of means is not to be neglected. Of the whole materia medica, camphor is the most reliable. It is given in doses of ten, twenty or even thirty grains, and often arrests the sudden sinking of the powers of life, and determines a speedy recovery. At the same time alcoholic stimulants, sulphate of quinia, food and sinapsims are employed.
For the diarrhæa and dysentery, the cretaceous mixture, hydrarg. cum creta, astringents, and diluted nitric acid, with laudanum, are the usual prescriptions.
Montreal, September 3d. A large number are sick in the sheds at this place; attacked, of course, after they had left the quarantine ground. A great proportion of them are said to have disentery. The deaths are numerous, The fever, here, is by no means confined to immigrants, but has invaded the city, and added greatly to its ordinary summer mortality. Its victims, however, are largely of that class which, living near the wharves, received and mingled with the immigrants, before sheds were provided for their reception. In conversing with several of the most intelligent physicians here, I find the treatment to be substantially the same as at Gros Isle and Quebec; but latterly, as Dr. Badgely informed me, increasing reliance is placed on nitric acid. He uses the following formula :—R. Acid nitr. 3j.; alcohol, Ziv.; aquæ ziv. Misce. An ounce is to be given every hour, beginning early in the disease, and without much preparation of the system. Under its administration, he and other gentlemen have, as he assured me, seen the pulse rapidly reduced in frequency, with a corresponding abatement of all the febrile symptoms.
When at Gros Isle I inquired as to post-mortem inspections, and could hear of only two. They were made by Dr. Wati, who found the liver engorged, and, as he believed, fatty. The state of the organs convinced him that the one mentioned suffered more than any other, which led him to prescribe purges of calomel and gamboge. In Quebec I could not learn that any dissections had been made. In this city Dr. Fraser has published, in the July No. of Dr. Hall's valuable “ British American Journal of Medical and Physical Sciences,” a short paper, in which he says :
“ The morbid appearances found on dissection, are venous conges. tion, with effusion of serum on the surface, in the ventricles, and base of the brain, but no trace of active inflammation. When the case has been complicated with bronchitis, I have found the bronchial
mucous membrane throughout, tumid, swollen, highly vascular, and containing much mucus ; the vascularity extending to the submucous tissue, with congestion and partial hepatization of portions of the lungs. When diarrhea has existed, the small intestines, es pecially the lower portion of the ileum, has presented the appearance of active congestion of its mucous coat, which was slightly thickened, without being softened; some patches had the appearance of sanguineous extravasation, not unlike the maculæ observed on the skin. When the patient had a jaundiced appearance, a common occurrence in this epidemic, I have found the liver enlarged from congestion, presenting a bloody and bilious appearance when cut into, and the gall bladder distended with inspissated bile, thick enough to maintain its form when deprived of its covering. When there has been only a slight bilious tinge of the skin and conjunctivæ, the liver presented the same appearance in a less degree, the bile in the gall-bladder being about the consistence of ireacle."
Dr. Fraser does not tell us how many autopsies he had made ; and we cannot but regret that so little has been done, where the oppor tunities are so great. It may be given in extenuation, however, that the physicians in attendance are overworked, and that many of them have been ill with the fever.
I have no time to give you the statistics of this disease, had I been able to collect full data. The nuinber of deaths, in proportion to that of the cases, never will be known, as nearly every form of disease in the immigrants goes very much under one name.
I inay say, in general terms, that the mortality has been, and still continues, great. Take the following as specimens. At Gros Isle, for the week preceding the 24th of August, the number of patients averaged more than 2,000, and the deaths amounted to 288. In the Marine and Emigrant Hospital of Quebec, the average for the week ending the 21st of August was about 850, the deaths 166; to which might be added 34 said to have died of dysentery, a sequel of the fever. The Montreal returns would be about the same; and present, in the ag: gregate, about 100 deaths a day at the three places. At Gros Iste alone, up to the 20th of August, the deaths had amounted to 2116. The disease had then prevailed about three months. them, however, have resulted from smallpox, which has prevailed to a considerable extent on the island, and more or less, I believe, in Quebec and Montreal, certainly in the latter, where I saw it in the General Hospital.
The British government have lately made an effort to arrest the fever by disinfecting agents. Dr. Stratton, of the Royal Navy, but sojourning in Upper Canada, has been commissioned to this enterprise, and arrived in Quebec while I was there. He was advised that two agents would be forwarded to hiin. One proved, on opening the package, to be Sir William Burnett's patent 'disinfecting fluid ; the other, a small bale of dresses for a lady! which had been forwarded from Halifax (by mistake) instead of 'Ledoyen's disinfecting fluid
. The former (of which Dr. Stratton kindly presented me with a small
A portion of
vial, which I carry in my trunk as an amulet) is said by the medical gentlemen of this quarter, to be a solution of the chloride of zinc. The latter, according to Dr. Hall, is a liquor of nitrate of lead. When I left Quebec, arrangements were making for experiments in the Marine Hospital, but its physicians seemed to think lightly of the practical value of such measures. When I was at Gros Isle, Dr. Douglas, the Quarantine Physician, sagaciously remarked, that the proper place for such experiments is an emigrant ship on her voyage.
In conclusion, I must beg of you to correct at least the grosser blunders of style, which are unavoidable in the circumstances under which I have written this most hurried epistle. With all its imperfections, it may, however, be of some interest to such of your readers as may not have seen much of what may have have been written by others on the Irish epidemic; and in that conviction I disiniss it, by subscribing myself, very respectfully,
Your ob't servant,
Massachusetts Medical Society.--A quarterly meeting of the Counsellors of this Sociery was held at the Masonic Temple on Wednes. day last, the day the Journal is published, which precluded the possibility of inserting even a synopsis of the transactions in that No. There has not been so many Counsellors together at an ordinary business meeting within the compass of our recollection. The circumstance even quite astonished one gentleman, who expressed his surprise, and exclaimed—“Mr. President, what is the meaning of this unusual congregation? Is there some design in it?" Dr. Howe, of Billerica, contrary to an impression abroad, took the chair, having withdrawn his letter declining the honour of the presidency. A long and unnecessarily tedious debate occurred in regard to a short report from the delegates of the Society to the National Medical Convention. Closely upon that, another came upon the tapis, which would have been admirable in a legislative body, where the object was solely to occupy the time in order to keep off another subject.
Everything else having been satisfactorily disposed of, Dr. Childs, of Pittsfield, introduced the following resolution :
" Whereas, The great object of medical association is the advance. ment of medical science, and the promotion of harmony and good feeling in the profession, thereby contributing to the best interests of society-and whereas the present organization of the Massachusetts Medical Society does not fully meet these important objects—therefore, Resolved, that a change in the organization of the Massachusetts Medical Society is in our opinion deemed both wise and expedient, and that the change consist in making the basis of the State Society, local or county associations ; in other words, having the State Society constituted by delegates annually chosen by the county associations, agreeably to the principle adopted in the States of Connecticut, New York, Vermont, Ohio, and in most of the States in the Union.”
Its introduction was like sending a fire-brand into a magazine of wet powder. There was nu sudden explosion, but a general move. ment on the surface. By little and little, the ignition extended, and
such a warming up of the quiescent old furnace has not occurred in that sedate circle for many a day. The Counsellor from Berksbire expressed himself with an unusual degree of energy and eloquence. Even those who most staunchly opposed the measures advocated by him for a re-organization of the Society, so that the profession in the western counties may profit by the association, admitted that the speaker was a man of strength, who pleaded his cause with com. manding force and dignity. We shall not detail the various propo. sitions for throwing overboard the petition for a remodelling of this venerable institution, which has, for a period of sixty years, conducted so many physicians and surgeons in peace, security and respectability; nor advert to the cogent and ingenious arguments urged upon the Council in favour of the scheme. After a protracted, as well as ercited session, an unmistaken evidence of impatience being manifested by those wishing to take the afternoon cars, as well as by another division accustomed to dining before tea-time, a large committee was raised, to whom the subject was referred, and a report may be erpected at the next meeting in February, when, it may safely be predicted, the Council will again be well attended.
Drs. Jeffreys of Boston, Peirson of Salem, Walker of Boston, Bartlett of Concord, and Childs of Pittsfield, were the prominent speakers on this exciting question. While some regretted, in private conversation, the introduction of this apple of discord, others were delighted with the discovery that there was some excitability in what they had doubtless considered as dry bones.
When the Berkshire gentleman memorialized the General Court the past winter, and stated sundry grievances, such as the local wants of the members residing at a distance from Boston, and also the noticeable fact that about one hundred regularly-educated physicians, in western Massachusetts, could not become members of the Society in its present imperfect condition, the petition was very summarily put under the table, or, what was equivalent thereto, disregarded by the committee, which aroused the Æsculapian blood on the sun-setting side of the Berkshire hills, whose excited members now seem disposed, like General Taylor, never to surrender.-Boston Med. and Surg. Journal.
Case of Poisoning by Vinegar. By A. H. David, M.D., Montreal. -Poisoning by acetic acid is so uncommon an occurrence, I have to request a small portion of your valuable columns for the details of a case I met with a few days ago; in which the patient—a widow woman, with four children—took, as near as I could ascertain, a quart bowlful of common vinegar. It appears that she had been dull and low spirited for two or three days previous, in consequence of the ne. glect (as her friends suppose) of a person from whom she had received the most marked attention, and to whom she had been attached prior to her marriage with her late husband. When I saw her, about three hours after she had taken the vinegar, she was in bed,