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ATTENDANCE ON CHOLERA PATIENTS AT DISPENSARIES.
220 CASE 1.—G. Jaged thirty-nine. Rice-water evacuacold extremities. Calomel (two-grain pills) every ten minutes. Reaction in ten hours. Rapid recovery. CASE 2.-J. D-, aged ten. tulseless and cold; occasional cramp. Calomel (one-grain pills) every five minutes; acidulated rice-water. Reaction in fourteen hours; no consecutive fever. CASE 3.--G. J-,aged forty-one. Pulseless, cold, and blue. Calomel (two-grain pills) every five minutes; turpentine-andbrandy every quarter of an hour. Never rallied. CASE 4: -J. B—,aged thirty-eight. Severe cramp, with feeble pulse, and rice-water purging. Calomel (two-grain pills) every fiveminutes; acidulated rice-water; sponging with aqua regia. Recovery in three days. . CASE 5.-T. W--, aged fifty-six. Purging and vomiting; cold and blue extremities. Calomel (two-grain pills) every ten minutes; cold drinks and sponging. Reaction in sixteen
tions ;
hours, and gradual
every quarter of an action in three hours.
hour; acidulated rice-water,
&c.
Re-
Result.—Recoveries, eighteen; deaths, six. These cases are given in order, as they have occurred to me
not selected, but in nractice.
I remain. Sir, yours obliged. W. J. Cox, M.R.C.S., &c.
ATTENDANCE ON CHOLERA PATIENTS AT DISPENSARIES. To the Editor of TiaiE LANCET. SIR,—I regret that I have not till now had leisure to acknowledge, with a few brief comments, your notice of my
letter, inserted the week before last.
Supposing the question of gratuitous attendance on cholera raised before a dispensary committee, you remark that "the medicàlofficer would naturally look to his contract on accepting office2’ Now, in the absence of any precise stipulations or exceptions, the nature of the contract must in equity be interpreted by the circumstances in which it was made. For instance, when I accepted office nearly five years ago, I never dreamed of making any stipulation in regard to cholera. Why ? Because the duty of the community to provide cholera hospitals, and the propriety (if not necessity) of removing all poor cholera patients from their homes to these hospitals, was all but universally recognised. I could not be supposed to contemplate the probability of being called, as a matter of course, to treat at their homes patients who were, as a matter of course, supposed to be sent to the hospital, to be tended by medical officers - specially engaged’ and remunerated for that purpose. In other words, I could not be supposed to anticicases
recovery. CASE 6.-S. W--, aged twenty-one. Pulseless, cold, and blue. Calomel (two-grain pills) every five minutes. Reaction in twenty hours, and gradual recovery until the third day, when she miscarried, and died in six hours. CASE 7.-J. W-, aged twenty-four. Pulseless and cold. No treatment for six hours. Calomel (two-grain pills) every five minutes ; brandy-and-turpentine. Reaction in sixteen hours. Died on the fourth day, of secondary fever. CASE 8.-W. H--, aged forty-one. Vomiting and cramp. Calomel (two-grain pills) every quarter of an hour; acidulated rice-water, and sponging. Rapid recovery. CASE 9.—S. B--, aged forty-two. Well marked collapse, but no cramps. Calomel (two-grain pills) every ten minutes; acid drinks. Reaction in twelve hours and slow recovery. pate the manifesto of the Board of Health. But had I acCASE 10.-E. R-, aged forty-two; of intemperate habits. cepted office after the appearance of that manifesto, without Extreme collapse. Calomel (two - grain pills) every five protesting against the imposition of so great an additional minutes; sponging, &c. Died in ten hours. Treatment greatly burden asthat which they, by implication, proposed to lay upon the dispensary physicians, I should consider myself neglected by friends. CASE 11.—M. J--, aged twenty-nine. Violent cramp and to have tacitly acquiesced in the propriety of their recom. rapid collapse. Calomel (two-grain pills) every ten minutes; mendation. But I am very far from thinking, as you seem to suppose, sponging, and acidulated rice-water. Reaction in six hours, that even a favourable issue of such a movement as would be and gradual recovery. CASE 12.-J. D--, aged forty-six. Rice-water evacuations, necessary to carry out the views I have endeavoured to exbut no cramps. Calomel (two-grain pills) every half-hour. press, would set at rest the dispensary question. And so far Collapse supervening. Calomel every ten minutes, and am I from wishing to " shirk the whole question," that it is not sponging. Reaction in nine hours. my fault that it was not taken up in right earnest more than CASE 13.-J. C-,aged thirteen. Extreme collapse. No a year ago. Having, then, the prospect of being able to draw treatment for eight hours. Calomel every five minutes. to the consideration of the mischief the attention of those who could largely aid in providing a remedy, I set about drawNever rallied. CASE 14.-T. W-, aged four. Intense collapse. Calomel ing up a statement, intended for your columns, of-the evils in. (one-grain pills) every five minutes. Reaction in fourteen separable from the present dispensary system, and suggesting a plan of reform. In spite of all my efforts at condensation, hours; rapid recovery. CASE 15.-M. D-, aged twelve. Intense collapse. Calomel this document, when completed, was plainly far too long for (one-grain pills) every five minutes; acidulated rice-water the pages of any journal, unless it were published piecemeal; and you know as well as I, that very few have patience to and sponging. Rapid reaction. CASE 16.-C. D-, aged forty-one.. Frightful cramp; col- wade through the disjointed fragments of a story, of which lapse supervening. Calomel (five grains in powder) every they have lost the thread, more especially when that story, if quarter of an hour; ice to the epigastrium; effervescents, with it is to have any practical effect, should be heard out at one After submitting the manuscript to several wellsulphuric and prussic acids. Complete recovery. , sitting. CASE 17.—J. W-, aged fifty-four. Little collapse, but ’, known public functionaries, and receiving their suggestions, as medical friends, who heartily concurred in my great vomiting and cramp. Calomel (four grains in powder) also to Iseveral every quarter of an hour; acidulated rice-water. Rapid re- views, made preparations for a speedy " confinement." But the accoucheur’s fee was an impossible one. I was told I lief, and gradual recovery. CASE 18.—T. B-, aged thirty-six. Excessive vomiting might have the assistance of a highly respectable author’s and cramp. Calomel (three grains in powder) every ten midwife, if I was prepared to stand a loss of £ 10, the ordinary fine for giving birth to a pamphlet. I preferred an indefinitely minutes; effervescents and sponging. Rapid recovery. CASE 19.-C. C-,aged thirty-one. Great and obstinate prolonged gestation. It has now been protracted between thirand fourteen months beyond the full time; yet, strange vomiting, but no cramps. Calomel (two-grain pills) every teen to say, there are signs that the feetal life is not extinct. When, quarter of an hour. Gradual recovery. if ever, the bantling shall see the light of the sun, I know not. CASE 20,—E. D , aged thirty-five. Intense collapse; Yours &c.. neglected for ten hours. Calomel (two-grain pills) every five A. P. STEWART. drinks. Never acidulated but died in sixminutes; rallied, teen hours. LAY OPINIONS ON LUNATIC ASYLUMS. CASE 21.-M. C-,aged sixty-four. Cramp and vomiting. To the Editor of THE LANCET. Calomel (four grains in powder) every half hour. Quick relief, and gradual recovery. SIR,—I am much obliged to you for the insertion of’nxy CASE 22.—W. M—, aged forty-one. Terrific cramp, cold- letter of July last in THE LANCET of the 4th of August, which ness, and failure of the pulse. Calomel (five grains in powder) gave the more satisfaction, as it justified the confidence which every ten minutes; sponging with aqua regia. Relief in two I placed in you as a man of gentlemanly feeling and of upright intention, when some of my medical friends had attempted hours, and complete recovery. CASE 23.-T. W-, aged fifty-two. Very severe cramps, to dissuade me from addressing you, thinking that I should coldness, and vomiting. Calomel (three grains in powder) only expose myself to slight or to ridicule. I will, if you will allow me, at some future period, explain every ten minutes; acid sponging. Relief in three hours, and to your satisfaction why the precautions taken by the legislaperfect recovery. CASE 24.-J. S-, aged thirty-one. Collapse, but no ture against the improper confinement or detention of persons cramps; nearly pulseless. Calomel (three grains in powder) in asylums, though not without value, are yet inefficient, and
tions ;
hours, and gradual
every quarter of an action in three hours.
hour; acidulated rice-water,
&c.
Re-
Result.—Recoveries, eighteen; deaths, six. These cases are given in order, as they have occurred to me
not selected, but in nractice.
I remain. Sir, yours obliged. W. J. Cox, M.R.C.S., &c.
ATTENDANCE ON CHOLERA PATIENTS AT DISPENSARIES. To the Editor of TiaiE LANCET. SIR,—I regret that I have not till now had leisure to acknowledge, with a few brief comments, your notice of my
letter, inserted the week before last.
Supposing the question of gratuitous attendance on cholera raised before a dispensary committee, you remark that "the medicàlofficer would naturally look to his contract on accepting office2’ Now, in the absence of any precise stipulations or exceptions, the nature of the contract must in equity be interpreted by the circumstances in which it was made. For instance, when I accepted office nearly five years ago, I never dreamed of making any stipulation in regard to cholera. Why ? Because the duty of the community to provide cholera hospitals, and the propriety (if not necessity) of removing all poor cholera patients from their homes to these hospitals, was all but universally recognised. I could not be supposed to contemplate the probability of being called, as a matter of course, to treat at their homes patients who were, as a matter of course, supposed to be sent to the hospital, to be tended by medical officers - specially engaged’ and remunerated for that purpose. In other words, I could not be supposed to anticicases
recovery. CASE 6.-S. W--, aged twenty-one. Pulseless, cold, and blue. Calomel (two-grain pills) every five minutes. Reaction in twenty hours, and gradual recovery until the third day, when she miscarried, and died in six hours. CASE 7.-J. W-, aged twenty-four. Pulseless and cold. No treatment for six hours. Calomel (two-grain pills) every five minutes ; brandy-and-turpentine. Reaction in sixteen hours. Died on the fourth day, of secondary fever. CASE 8.-W. H--, aged forty-one. Vomiting and cramp. Calomel (two-grain pills) every quarter of an hour; acidulated rice-water, and sponging. Rapid recovery. CASE 9.—S. B--, aged forty-two. Well marked collapse, but no cramps. Calomel (two-grain pills) every ten minutes; acid drinks. Reaction in twelve hours and slow recovery. pate the manifesto of the Board of Health. But had I acCASE 10.-E. R-, aged forty-two; of intemperate habits. cepted office after the appearance of that manifesto, without Extreme collapse. Calomel (two - grain pills) every five protesting against the imposition of so great an additional minutes; sponging, &c. Died in ten hours. Treatment greatly burden asthat which they, by implication, proposed to lay upon the dispensary physicians, I should consider myself neglected by friends. CASE 11.—M. J--, aged twenty-nine. Violent cramp and to have tacitly acquiesced in the propriety of their recom. rapid collapse. Calomel (two-grain pills) every ten minutes; mendation. But I am very far from thinking, as you seem to suppose, sponging, and acidulated rice-water. Reaction in six hours, that even a favourable issue of such a movement as would be and gradual recovery. CASE 12.-J. D--, aged forty-six. Rice-water evacuations, necessary to carry out the views I have endeavoured to exbut no cramps. Calomel (two-grain pills) every half-hour. press, would set at rest the dispensary question. And so far Collapse supervening. Calomel every ten minutes, and am I from wishing to " shirk the whole question," that it is not sponging. Reaction in nine hours. my fault that it was not taken up in right earnest more than CASE 13.-J. C-,aged thirteen. Extreme collapse. No a year ago. Having, then, the prospect of being able to draw treatment for eight hours. Calomel every five minutes. to the consideration of the mischief the attention of those who could largely aid in providing a remedy, I set about drawNever rallied. CASE 14.-T. W-, aged four. Intense collapse. Calomel ing up a statement, intended for your columns, of-the evils in. (one-grain pills) every five minutes. Reaction in fourteen separable from the present dispensary system, and suggesting a plan of reform. In spite of all my efforts at condensation, hours; rapid recovery. CASE 15.-M. D-, aged twelve. Intense collapse. Calomel this document, when completed, was plainly far too long for (one-grain pills) every five minutes; acidulated rice-water the pages of any journal, unless it were published piecemeal; and you know as well as I, that very few have patience to and sponging. Rapid reaction. CASE 16.-C. D-, aged forty-one.. Frightful cramp; col- wade through the disjointed fragments of a story, of which lapse supervening. Calomel (five grains in powder) every they have lost the thread, more especially when that story, if quarter of an hour; ice to the epigastrium; effervescents, with it is to have any practical effect, should be heard out at one After submitting the manuscript to several wellsulphuric and prussic acids. Complete recovery. , sitting. CASE 17.—J. W-, aged fifty-four. Little collapse, but ’, known public functionaries, and receiving their suggestions, as medical friends, who heartily concurred in my great vomiting and cramp. Calomel (four grains in powder) also to Iseveral every quarter of an hour; acidulated rice-water. Rapid re- views, made preparations for a speedy " confinement." But the accoucheur’s fee was an impossible one. I was told I lief, and gradual recovery. CASE 18.—T. B-, aged thirty-six. Excessive vomiting might have the assistance of a highly respectable author’s and cramp. Calomel (three grains in powder) every ten midwife, if I was prepared to stand a loss of £ 10, the ordinary fine for giving birth to a pamphlet. I preferred an indefinitely minutes; effervescents and sponging. Rapid recovery. CASE 19.-C. C-,aged thirty-one. Great and obstinate prolonged gestation. It has now been protracted between thirand fourteen months beyond the full time; yet, strange vomiting, but no cramps. Calomel (two-grain pills) every teen to say, there are signs that the feetal life is not extinct. When, quarter of an hour. Gradual recovery. if ever, the bantling shall see the light of the sun, I know not. CASE 20,—E. D , aged thirty-five. Intense collapse; Yours &c.. neglected for ten hours. Calomel (two-grain pills) every five A. P. STEWART. drinks. Never acidulated but died in sixminutes; rallied, teen hours. LAY OPINIONS ON LUNATIC ASYLUMS. CASE 21.-M. C-,aged sixty-four. Cramp and vomiting. To the Editor of THE LANCET. Calomel (four grains in powder) every half hour. Quick relief, and gradual recovery. SIR,—I am much obliged to you for the insertion of’nxy CASE 22.—W. M—, aged forty-one. Terrific cramp, cold- letter of July last in THE LANCET of the 4th of August, which ness, and failure of the pulse. Calomel (five grains in powder) gave the more satisfaction, as it justified the confidence which every ten minutes; sponging with aqua regia. Relief in two I placed in you as a man of gentlemanly feeling and of upright intention, when some of my medical friends had attempted hours, and complete recovery. CASE 23.-T. W-, aged fifty-two. Very severe cramps, to dissuade me from addressing you, thinking that I should coldness, and vomiting. Calomel (three grains in powder) only expose myself to slight or to ridicule. I will, if you will allow me, at some future period, explain every ten minutes; acid sponging. Relief in three hours, and to your satisfaction why the precautions taken by the legislaperfect recovery. CASE 24.-J. S-, aged thirty-one. Collapse, but no ture against the improper confinement or detention of persons cramps; nearly pulseless. Calomel (three grains in powder) in asylums, though not without value, are yet inefficient, and