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EPIDEMIC TYPHUS FEVER IN THE COUNTY OF TIPPERARY.
795
ed with that disease, which, from its believed EPIDEMIC TYPHUS FEVER contagiousness, we might naturally have ex-
pected, where the proximity
IN THE
was so
COUNTY OF TIPPERARY. To the Edito1’
to
the disease
great.
The fever which prevailed here, although differing in other respects from that described by Dr. Kelso, assumed the malignant
of THE LANCET. and form. In all cases I found interesting account thereepidemic :-Having existed gastro-intestinal disease ; in of an epidemic fever, in THE LANCET for there was also pneumonia, running Out. 6, 1838, by Dr. Kelso, of Lisburn, Ire- many into hepatisation of the lung. The rapidly of an a land, 1 send you report epidemic, pulse averaged from 120 to 140, generally with cases, which occurred in this neighThere was cough, of a bourhood at about the .ame period, although incompressible. troublesome at first unaccomvery nature, it was not marked with the same complicapanied with sputa, but afterwards copious tion as is described bv Dr. Kelso. expectoration followed the use of pectoral I remain, Sir, your obliged, medicines. The cheeks were flushed and MICHAEL J. MAC MACCORMACK, CORMACK, M.D., Physician to the Mullinalione Dispensary, eyes suffused in a greater or less degree, County Tipperary. according to the intensity of the cerebral Mulliriahone, Callan, symptoms. The skin was covered with petechiae, sometimes assuming a dusky hue, Feb. 8, 1839. and in fatal cases I found a tendency to purIn the month of December, 1837, shortly pura haemorrhagica. The tongue and teetli after obtaining charge of this dispensary, were covered with a black sordes ; the lips typhus fever raged to a frightful extent in were dry and parched ; thirst was excessive this village and the surrounding country, in those cases where gastro-enteritis existed. SIR
seen an
which I found, on inquiry, had been prevalent for the previous two months. Having no fever hospital here, my patients were not so immediately under my inspection as I could have wished, neither had I the advantages in the treatment which an hospital would have afforded. However, I had not that great mortality which I was led to anticipate from the filth which in general prevails among the Irish peasantry, and from the crowded state of their dwellings, five or six individuals, with several pigs, &c., being congregated in a space scarcely ten feet square, all sleeping in the same bed, and in many instances with the sick person. As the thought just occurs to me, I would ask, might not the erysipelas, which accompanied the fever in Lisburn, have been caused by the crowded state and want of proper ventilation, which Dr. Kelso states as having existed, and which we too often find in country hospitals ; it appears to me aualogotis to hospital gangrene, which we find the result of such a state as the above, viz. bad - air and crowded wards ; the analogy is still stronger where erysipelas terminates in suppuration and sloughing. The account of Dr. Kelso I think of very great interest to the profession at large on account of the rarity of such an attendant on fever. For my part, I cannot call to my recollection having either read of or seen such a complication, although having had an extensive field for observation, while attending, for better than two years, the practice of two large hospitals in Dublin, in which the fever
patients daily averaged
50
or
60, during
which period I have seen erysipelas in the same wards, and in the next bed to those labouring under typhus ; yet in no one instance did I ever see a fever patient attack-
Pain of a very acute nature was found over the whole abdomen, particularly in the ileocascal region; the belly became tympanitic generally on the third or fourth day; delirium of a violent nature was present in all fatal cases. There was great prostration of strength from the very onset of the attack, which required the administration of whiskey, either pure or diluted, camphor mixture, and other stimulants, to keep death as it were, at bay, which prostration I always looked on as indicating great danger, and very often death. Sloughing sores on the ba,?k and hips made their appearance in such cases of prostration early, and spread with a frightful rapidity ; depending, as it were, on a want of due circulation in the system. Not having the benefit of careful and cleanly nurses, I lost a great number of those patients, except where I saw them
early, and, as was my constant rule, inspected carefully every place where I saw there I would here was the slightest pressure. mention a line of treatment which I pursued in these cases, and which I invariably found attended with success ; it was this, on the first appearance of any redness or abrasion of the skin, I coated the parts affected with successive layers of a table varnish (composed of camphor, spirits of lime, bee’s-wax), allowing each layer to dry before applying the next ; in this manner, after five or six coats, there was formed an artificial cuticle, which always prevented the spread of the inflammation. I do not intend to take on myself the originality of this treatment. I first learned its use and benefit while attending the lectures and clinical practice of Dr. Lendrick, in Sir P. Dun’s Hospital. From the success which I found attending this remedy, I have no hesitation in recommend-
796 it strongly to the profession, at least topetechiæ I ; tongue large, covered at point, such as may not yet have either heard of it dorsum, and edges, with a thick yellowish 1 or employed it. The breath (in a case which fur ; back thickly covered with petechia?. I subjoin, and in which the patient laboured I ordered himunder pneumonia) was intolerable Whiskey punch, eight ounces ; half an so much so, that it was quite disgusting at ounce every second hour. Contin. remedies. many feet from the bed, and for some time 1 13. Pulse 108, small and feeble; tonalte suspected gangrene of the lung:. Deafness was universally attendant on this epidemic, reddish-brown and dry in the centre, puts it and was a marked symptom of disease going out rather tremulously ; body entirely coon in the brain or its membranes. As in the vered with petechiae; belly tympanitic ; epidemic of 1835-6, there was no marked raved during the night.—Ordered him to crisis, nor did any change manifest itself on continue the punch and the medicines. those days which medical writers lay down 14. Subsultus tendinum ; pulse 100, soft, as those on which we might expect a change, and compressible ; tongue brown in centre, favourable or otherwise ; in one or two in- white at point and edges; countenance imstances, however, convalescence was mani- proved.—Repeat the punch. .latnes’.s powder, six grains fest after a discharge of blood from the nostrits and rectum. As to the causes of the i Camphor, eight grains; Carbon. of ammon., twelve grains; epidemic, I believe its origin was distinctly referrible to the variableness of the weather, Syrup, q.s. Make four pills; one every fourth liour. Stupe the legs and ab together with the filthy habits of the peadomen with turpentine. santry, as this form of epidemic was peculiarly confined to the very lower classes. I i 15. Pulse 96 ; tongue still dry and brown, give three of the most remarkable cases as rough in centre ; belly less tympanitic ; suban illustration of the general form which the sultus ; face less flushed;. countenance ini-
ing
of ensive,
disease assumed.
proved.-Repeat medicines.
16. Pulse 80, with some degree of firm. aet. 21.-Dec. ness ; belly not tympanitic; tongue moist. 8th. Saw him to-day ; says he has been ill - Omit pill. a week ; attributes his illness to cold, proCairapiior mixture, one onnce, every duced by a wetting. Was hrst attacked third hour. with pains in all his bones, back, and in the 17. Tongue still dry and brown in centre, head. Present symptoms.—Face flushed ; moist at point and edges; marked improveeyes suffused ; tongue red at point and edges, ment. 18. Convalescent. greyish-white on surface ; lips red ; gums spongy and soft; pulse 130, soft; skin hot, with circumscribed petechiae, especially on CASE 2.-Thomas Dunphy, set. 16, ill chest and abdomen; tympanitis not very since Dec. 6th.-8th. Pulse 1-0, small, heat remarkable ; pain over the whole abdomen, moderate; tongue greyish, white on dorbut particularly in the ileo-cæcal region ; sum, red at point and edges ; lips red; face thirst.—Six leeches behind the ears ;Jame’s not flushed; dark livid circle rouud the powder, two grains, every huur. Cold lotions eyes ; anxious expression of face ; sick, to the forehead ; fomentations to legs ; whey heavy breath ; abdomen very tender on presto drink. sure ; raved incessantly during the night. 10. Raved during the night; face much Head to be shaved, and the bowels not havflushed ; tongue bright-red at point and dor- ing been moved for several days, I ordered sum, rough and dry ; lips and teeth covered him a turpentine enema at once, and fomentawith black sordes ; skin more thickly cover- tions to the legs. ed with petechiæ ; pulse 136, shabby ; moCalomel, three grains; derate subsultus ; speaks thick ; belly tymScammony and jalap potcder, four grains. To be taken at once. Cold lotion to panitic ; ileo-cæcal tenderness ; insatiable forehead. thirst.—Head to he shaved. James’s powder, two grains, every six Cunzlrlioo mixture, one ounce,every third hours. hour. 9. Burning acrid heat of skin ; counteCarboncete of ammon., twelve grains nance bespeaking great distress; livid circle James’s poit-dey-, six grains ; round the eyes ; legs kept continually drawn Ipecac, powder, three grains ; Syrup, q.s. Mal:a four pills ; one every up towards the abdomen ; pulse 140 ; abdothird hour. Six leeches to abdomen, men hard and tympanitic; will ouly take cold water; cough very severe; passed a and then a large pouttice. 12. Pulse 120, soft and compressible ; great quantity of solid faeces after the in. sbsultus tendinum ; face still flushed and jection.—Repeat enema and fomentations. Calomel, eight grains ; eyes suffused, giving his face the appearance of a person intoxicated ; lips covered with James’s powder, twelve graius; black sordes; gums soft and spongy ; abdo. Ipecac. powder, three grains. Divide into
CASE
men
1.-Henry Meagher,
tympanitic, and thickly covered with
four
powders ;
one
every third hour,
797 10. Pulse 140 ; abdomen not so hard, but still tympanitic ; injections brought away a great quantity of solid fæces ; tongue red at point and edges, and white on surface ;
hard, dry cough ; continually moaning ; keeps the legs constantly drawn up to the abdomen ; eyes suffused ; breath very ofleu-
Calomel, eight grains; James’s powder, twelve gi-ains Carbonate of ammon., twelve grains twelve grains ; q.s. Make six pills;
;
Camphor,
Syrup,
one
every
fourth hour.
Camphor naixlxcre,
one ounce, every second hour. Wine, half an ounce, in eaccler, every second hour. Shave the head ; cold lotion to forehead ; fomentation to tion. Cold lotion to forehead. abdomen. 11. The breath most intolerably offensive 13. Pulse 136 ; raved incessantly during expression of pulse 140 ; has a most countenance ; abdomen hard ; tongue thickly the night ; bowels free; skin cold and coated in the centre ; bowels not moved yes- clammy ; petechiae very abundant; is coma. tose, and does not recognise any one ; has terday morning.—Repeat enema. large sloughing sores on both hips and back Calomel, three grains ; James’s 1)owdej-, two grains. Take every to which I ordered a fomenting poultice.third hour. Fomentations to the legs. Repeat wine and other remedies. Chicken-broth. lo. Pulse 130, weak, irregular, and im12. Breath still dreadfully offensive ; perceptible for some seconds; pnpils conblack sordes on lips and teeth ; face expres- tracted ; skin cool and clammy; hurried and sive of great anguish; still keeps his legs difficult respiration ; passes all his evacuitdrawn up to the abdomen ; continually ask- tions under him. ing for cold water, will not drink anything Camphor mixture, one ounce, every hour. else. Wine, one ounce, every second hour. 13. Petechiæ appearing universally over Sinapisms to feet ; cold lotion to head. 17. Died this morning, at six o’clock. the whole body; face flushed; suffering As fever is our great antagonist in dispenmost acutely ; black sordes, gluing the lips together; pulse 140 ; breath not much im- sary practice, I merely wish to lay before proved.—Repeat powdersnd fomentations. my fellow-labourers in this district my ex16. No change worth mentioning till to- perience, and the success attendant upon the day, when petechiæ: appeared less; pulse treatment I pursued, leaving it to themselves 146; breath still dreadfully offensive. to choose what they may think advantageSaline draughts; repeat powder. ous, and reject what does not appear so to 17. Pulse 130; general amendment; breath them. still continues intolerable ; black sordes on the lips.-Continue medicines ; honey and borax to be applied to the lips.
sive.-Repeat powders. Barley decoction, eight ounces Castor oil, two ounces. Makeaninjec-
painful
ABSTRACT pulse 110; bowels I ordered a OF THE days, turpentine enema in the evening. EVIDENCE OF DR. R. D. THOMSON, 19. Pulse 100 ; bowels freed ; appetite RELATIVE TO THE returning; breath much improved; tongue OF DRUGS : ADULTERATION moist, clean, except at the base ; cough less, with copious expectoration.-Ordered him Delivered before the Select Committee of the House
18. Tongue cleaning; not being opened for two
chicken-broth and two 20. Convalescent.
ounces
of wine.
of Commons
on
the Poor-Law Amendment Act.
15533. MR. WAKLEY.—Are many medical CASE 3.-Edward Morony, ill ten days. substances rendered useless in consequence Dec. 10th. Illness began with headach, pains of the defective manner in which they are in his joints and back, brought on by a se- prepared ?-Extracts, from the nature of the vere wetting; pulse 140, feeble; tongue process recommended in the Pharmacopoeia, thick, covered with a dry brown fur in are very often useless, because the processes centre, red at point and edges; cough ; require very great attention. 15.334. Through how many hands do mebronchial i-hles in the upper part of the right pass before they generally lung ; petechiæ very abundant; belly tympanitic ; skin dry and hot ; great prostration reach the consumer?—Drugs are collected of strength ; insatiable thirst,.—Purgative in the countries from which they derive their origin, by the natives of those coundraught. 11. Pulse 138,feeble ; tongue dry, covered they are purchased by a merchant, with a black crust in centre ; pupils con- who imports them into this country ; this tracted ; raved incessantly through the merchant employs a broker, who sends the night ; bowels were freed by the purgative drugs, if they are capable of being readily draught ; passes all his evacuations involun- tested, to a scientific chemist. The rneditarily ; chest and abdomen covered with pe- cines which fall more particularly under head are saltpetre, sal ammoniac, and techiae circumscriptæ ;insatiable thirst.
dical substances
tries ;
this
ed with that disease, which, from its believed EPIDEMIC TYPHUS FEVER contagiousness, we might naturally have ex-
pected, where the proximity
IN THE
was so
COUNTY OF TIPPERARY. To the Edito1’
to
the disease
great.
The fever which prevailed here, although differing in other respects from that described by Dr. Kelso, assumed the malignant
of THE LANCET. and form. In all cases I found interesting account thereepidemic :-Having existed gastro-intestinal disease ; in of an epidemic fever, in THE LANCET for there was also pneumonia, running Out. 6, 1838, by Dr. Kelso, of Lisburn, Ire- many into hepatisation of the lung. The rapidly of an a land, 1 send you report epidemic, pulse averaged from 120 to 140, generally with cases, which occurred in this neighThere was cough, of a bourhood at about the .ame period, although incompressible. troublesome at first unaccomvery nature, it was not marked with the same complicapanied with sputa, but afterwards copious tion as is described bv Dr. Kelso. expectoration followed the use of pectoral I remain, Sir, your obliged, medicines. The cheeks were flushed and MICHAEL J. MAC MACCORMACK, CORMACK, M.D., Physician to the Mullinalione Dispensary, eyes suffused in a greater or less degree, County Tipperary. according to the intensity of the cerebral Mulliriahone, Callan, symptoms. The skin was covered with petechiae, sometimes assuming a dusky hue, Feb. 8, 1839. and in fatal cases I found a tendency to purIn the month of December, 1837, shortly pura haemorrhagica. The tongue and teetli after obtaining charge of this dispensary, were covered with a black sordes ; the lips typhus fever raged to a frightful extent in were dry and parched ; thirst was excessive this village and the surrounding country, in those cases where gastro-enteritis existed. SIR
seen an
which I found, on inquiry, had been prevalent for the previous two months. Having no fever hospital here, my patients were not so immediately under my inspection as I could have wished, neither had I the advantages in the treatment which an hospital would have afforded. However, I had not that great mortality which I was led to anticipate from the filth which in general prevails among the Irish peasantry, and from the crowded state of their dwellings, five or six individuals, with several pigs, &c., being congregated in a space scarcely ten feet square, all sleeping in the same bed, and in many instances with the sick person. As the thought just occurs to me, I would ask, might not the erysipelas, which accompanied the fever in Lisburn, have been caused by the crowded state and want of proper ventilation, which Dr. Kelso states as having existed, and which we too often find in country hospitals ; it appears to me aualogotis to hospital gangrene, which we find the result of such a state as the above, viz. bad - air and crowded wards ; the analogy is still stronger where erysipelas terminates in suppuration and sloughing. The account of Dr. Kelso I think of very great interest to the profession at large on account of the rarity of such an attendant on fever. For my part, I cannot call to my recollection having either read of or seen such a complication, although having had an extensive field for observation, while attending, for better than two years, the practice of two large hospitals in Dublin, in which the fever
patients daily averaged
50
or
60, during
which period I have seen erysipelas in the same wards, and in the next bed to those labouring under typhus ; yet in no one instance did I ever see a fever patient attack-
Pain of a very acute nature was found over the whole abdomen, particularly in the ileocascal region; the belly became tympanitic generally on the third or fourth day; delirium of a violent nature was present in all fatal cases. There was great prostration of strength from the very onset of the attack, which required the administration of whiskey, either pure or diluted, camphor mixture, and other stimulants, to keep death as it were, at bay, which prostration I always looked on as indicating great danger, and very often death. Sloughing sores on the ba,?k and hips made their appearance in such cases of prostration early, and spread with a frightful rapidity ; depending, as it were, on a want of due circulation in the system. Not having the benefit of careful and cleanly nurses, I lost a great number of those patients, except where I saw them
early, and, as was my constant rule, inspected carefully every place where I saw there I would here was the slightest pressure. mention a line of treatment which I pursued in these cases, and which I invariably found attended with success ; it was this, on the first appearance of any redness or abrasion of the skin, I coated the parts affected with successive layers of a table varnish (composed of camphor, spirits of lime, bee’s-wax), allowing each layer to dry before applying the next ; in this manner, after five or six coats, there was formed an artificial cuticle, which always prevented the spread of the inflammation. I do not intend to take on myself the originality of this treatment. I first learned its use and benefit while attending the lectures and clinical practice of Dr. Lendrick, in Sir P. Dun’s Hospital. From the success which I found attending this remedy, I have no hesitation in recommend-
796 it strongly to the profession, at least topetechiæ I ; tongue large, covered at point, such as may not yet have either heard of it dorsum, and edges, with a thick yellowish 1 or employed it. The breath (in a case which fur ; back thickly covered with petechia?. I subjoin, and in which the patient laboured I ordered himunder pneumonia) was intolerable Whiskey punch, eight ounces ; half an so much so, that it was quite disgusting at ounce every second hour. Contin. remedies. many feet from the bed, and for some time 1 13. Pulse 108, small and feeble; tonalte suspected gangrene of the lung:. Deafness was universally attendant on this epidemic, reddish-brown and dry in the centre, puts it and was a marked symptom of disease going out rather tremulously ; body entirely coon in the brain or its membranes. As in the vered with petechiae; belly tympanitic ; epidemic of 1835-6, there was no marked raved during the night.—Ordered him to crisis, nor did any change manifest itself on continue the punch and the medicines. those days which medical writers lay down 14. Subsultus tendinum ; pulse 100, soft, as those on which we might expect a change, and compressible ; tongue brown in centre, favourable or otherwise ; in one or two in- white at point and edges; countenance imstances, however, convalescence was mani- proved.—Repeat the punch. .latnes’.s powder, six grains fest after a discharge of blood from the nostrits and rectum. As to the causes of the i Camphor, eight grains; Carbon. of ammon., twelve grains; epidemic, I believe its origin was distinctly referrible to the variableness of the weather, Syrup, q.s. Make four pills; one every fourth liour. Stupe the legs and ab together with the filthy habits of the peadomen with turpentine. santry, as this form of epidemic was peculiarly confined to the very lower classes. I i 15. Pulse 96 ; tongue still dry and brown, give three of the most remarkable cases as rough in centre ; belly less tympanitic ; suban illustration of the general form which the sultus ; face less flushed;. countenance ini-
ing
of ensive,
disease assumed.
proved.-Repeat medicines.
16. Pulse 80, with some degree of firm. aet. 21.-Dec. ness ; belly not tympanitic; tongue moist. 8th. Saw him to-day ; says he has been ill - Omit pill. a week ; attributes his illness to cold, proCairapiior mixture, one onnce, every duced by a wetting. Was hrst attacked third hour. with pains in all his bones, back, and in the 17. Tongue still dry and brown in centre, head. Present symptoms.—Face flushed ; moist at point and edges; marked improveeyes suffused ; tongue red at point and edges, ment. 18. Convalescent. greyish-white on surface ; lips red ; gums spongy and soft; pulse 130, soft; skin hot, with circumscribed petechiae, especially on CASE 2.-Thomas Dunphy, set. 16, ill chest and abdomen; tympanitis not very since Dec. 6th.-8th. Pulse 1-0, small, heat remarkable ; pain over the whole abdomen, moderate; tongue greyish, white on dorbut particularly in the ileo-cæcal region ; sum, red at point and edges ; lips red; face thirst.—Six leeches behind the ears ;Jame’s not flushed; dark livid circle rouud the powder, two grains, every huur. Cold lotions eyes ; anxious expression of face ; sick, to the forehead ; fomentations to legs ; whey heavy breath ; abdomen very tender on presto drink. sure ; raved incessantly during the night. 10. Raved during the night; face much Head to be shaved, and the bowels not havflushed ; tongue bright-red at point and dor- ing been moved for several days, I ordered sum, rough and dry ; lips and teeth covered him a turpentine enema at once, and fomentawith black sordes ; skin more thickly cover- tions to the legs. ed with petechiæ ; pulse 136, shabby ; moCalomel, three grains; derate subsultus ; speaks thick ; belly tymScammony and jalap potcder, four grains. To be taken at once. Cold lotion to panitic ; ileo-cæcal tenderness ; insatiable forehead. thirst.—Head to he shaved. James’s powder, two grains, every six Cunzlrlioo mixture, one ounce,every third hours. hour. 9. Burning acrid heat of skin ; counteCarboncete of ammon., twelve grains nance bespeaking great distress; livid circle James’s poit-dey-, six grains ; round the eyes ; legs kept continually drawn Ipecac, powder, three grains ; Syrup, q.s. Mal:a four pills ; one every up towards the abdomen ; pulse 140 ; abdothird hour. Six leeches to abdomen, men hard and tympanitic; will ouly take cold water; cough very severe; passed a and then a large pouttice. 12. Pulse 120, soft and compressible ; great quantity of solid faeces after the in. sbsultus tendinum ; face still flushed and jection.—Repeat enema and fomentations. Calomel, eight grains ; eyes suffused, giving his face the appearance of a person intoxicated ; lips covered with James’s powder, twelve graius; black sordes; gums soft and spongy ; abdo. Ipecac. powder, three grains. Divide into
CASE
men
1.-Henry Meagher,
tympanitic, and thickly covered with
four
powders ;
one
every third hour,
797 10. Pulse 140 ; abdomen not so hard, but still tympanitic ; injections brought away a great quantity of solid fæces ; tongue red at point and edges, and white on surface ;
hard, dry cough ; continually moaning ; keeps the legs constantly drawn up to the abdomen ; eyes suffused ; breath very ofleu-
Calomel, eight grains; James’s powder, twelve gi-ains Carbonate of ammon., twelve grains twelve grains ; q.s. Make six pills;
;
Camphor,
Syrup,
one
every
fourth hour.
Camphor naixlxcre,
one ounce, every second hour. Wine, half an ounce, in eaccler, every second hour. Shave the head ; cold lotion to forehead ; fomentation to tion. Cold lotion to forehead. abdomen. 11. The breath most intolerably offensive 13. Pulse 136 ; raved incessantly during expression of pulse 140 ; has a most countenance ; abdomen hard ; tongue thickly the night ; bowels free; skin cold and coated in the centre ; bowels not moved yes- clammy ; petechiae very abundant; is coma. tose, and does not recognise any one ; has terday morning.—Repeat enema. large sloughing sores on both hips and back Calomel, three grains ; James’s 1)owdej-, two grains. Take every to which I ordered a fomenting poultice.third hour. Fomentations to the legs. Repeat wine and other remedies. Chicken-broth. lo. Pulse 130, weak, irregular, and im12. Breath still dreadfully offensive ; perceptible for some seconds; pnpils conblack sordes on lips and teeth ; face expres- tracted ; skin cool and clammy; hurried and sive of great anguish; still keeps his legs difficult respiration ; passes all his evacuitdrawn up to the abdomen ; continually ask- tions under him. ing for cold water, will not drink anything Camphor mixture, one ounce, every hour. else. Wine, one ounce, every second hour. 13. Petechiæ appearing universally over Sinapisms to feet ; cold lotion to head. 17. Died this morning, at six o’clock. the whole body; face flushed; suffering As fever is our great antagonist in dispenmost acutely ; black sordes, gluing the lips together; pulse 140 ; breath not much im- sary practice, I merely wish to lay before proved.—Repeat powdersnd fomentations. my fellow-labourers in this district my ex16. No change worth mentioning till to- perience, and the success attendant upon the day, when petechiæ: appeared less; pulse treatment I pursued, leaving it to themselves 146; breath still dreadfully offensive. to choose what they may think advantageSaline draughts; repeat powder. ous, and reject what does not appear so to 17. Pulse 130; general amendment; breath them. still continues intolerable ; black sordes on the lips.-Continue medicines ; honey and borax to be applied to the lips.
sive.-Repeat powders. Barley decoction, eight ounces Castor oil, two ounces. Makeaninjec-
painful
ABSTRACT pulse 110; bowels I ordered a OF THE days, turpentine enema in the evening. EVIDENCE OF DR. R. D. THOMSON, 19. Pulse 100 ; bowels freed ; appetite RELATIVE TO THE returning; breath much improved; tongue OF DRUGS : ADULTERATION moist, clean, except at the base ; cough less, with copious expectoration.-Ordered him Delivered before the Select Committee of the House
18. Tongue cleaning; not being opened for two
chicken-broth and two 20. Convalescent.
ounces
of wine.
of Commons
on
the Poor-Law Amendment Act.
15533. MR. WAKLEY.—Are many medical CASE 3.-Edward Morony, ill ten days. substances rendered useless in consequence Dec. 10th. Illness began with headach, pains of the defective manner in which they are in his joints and back, brought on by a se- prepared ?-Extracts, from the nature of the vere wetting; pulse 140, feeble; tongue process recommended in the Pharmacopoeia, thick, covered with a dry brown fur in are very often useless, because the processes centre, red at point and edges; cough ; require very great attention. 15.334. Through how many hands do mebronchial i-hles in the upper part of the right pass before they generally lung ; petechiæ very abundant; belly tympanitic ; skin dry and hot ; great prostration reach the consumer?—Drugs are collected of strength ; insatiable thirst,.—Purgative in the countries from which they derive their origin, by the natives of those coundraught. 11. Pulse 138,feeble ; tongue dry, covered they are purchased by a merchant, with a black crust in centre ; pupils con- who imports them into this country ; this tracted ; raved incessantly through the merchant employs a broker, who sends the night ; bowels were freed by the purgative drugs, if they are capable of being readily draught ; passes all his evacuations involun- tested, to a scientific chemist. The rneditarily ; chest and abdomen covered with pe- cines which fall more particularly under head are saltpetre, sal ammoniac, and techiae circumscriptæ ;insatiable thirst.
dical substances
tries ;
this