At the Children's Asylum, all the weakly children were made to take bitters, of different descriptions; and Dr. Sylvester's antiscorbutic drink, composed of cream of tartar and juniper berries, infused in water. As the disease declined in the house, under this administration of bitters, it is highly probable that they had a preventive agency. I much question, however, whether Dr. Sylvester's drink was productive of any advantage.
One question of some importance yet remains. Has mercury any agency in producing this affection? The salivary glands have never been observed to be affected in it. Dr. Parrish informs me, that, after a strict examination, he has come to the conclusion that the previous use of mercury does not bring on, or aggravate this complaint, as he has noticed it. I have made the same observation; and, not being peculiarly sparing of the use of calomel in fevers, have had opportunities to verify it. I think I can add, that, in some cases, by shortening and moderating an attack of fever, calomel has been useful in preventing the ulceration. Given during the progress of one, and that a fatal case, it did not appear to aggravate it.
There is no evidence whatever tending to excite the suspicion of contagion.
Treatment.—A variety of remedies had been tried within my knowledge; most of them with but little success, and one or two with somewhat better. Feeling much disappointed with the results of my practice, in the small number of cases which fell under my care in the spring months at the Asylum, as well as elsewhere, I wished to exchange with another physician for a period when the disease was more prevalent; for the purpose of studying it, and making comparative trials of different remedies. Dr. Jos. G. Nancrede was so polite as to indulge me. Having then a large number of patients under my care, I was enabled to make more extensive observations, and with more precision; the results of which course gave me the first satisfaction I had ever felt relative to this disease. Trials were made of every thing that was suggested by friends, and generally upon 4 or 5 selected patients at a time. Thus, choosing them in the ulcerative stage, and having several at a time before our eyes, the result was seen in a very few days, much sooner than if patients had been successively subjected to the remedies; and no material time was lost in appealing to the article which appeared to answer best.
The remedy which beyond all comparison succeeded best, was sulphate of copper. The usefulness of this substance, though known at Salem, New Jersey, was discovered, at the Asylum, by the mistake of a nurse. It had been previously used, in lotions of the strength of gr. ij or iij to the ounce of water; and with little advantage. Observing that the empirical remedies said to have succeeded, were, as I considered them, immoderately strong, I furnished the nurse with a common solution of sulphate of copper, and with a vial containing 72 grains of the sulphate in an ounce of water, for the purpose of being progressively added to the other at different periods. This stronger solution was applied, by mistake, instead of the diluted one; and it was the first remedy which had produced a rapid tendency to a cure. I finally settled down, after various trials, in the employment of the following:
| R. Sulph. Cupri, | ℨij |
| Pulv. Cinchonæ, | ℥ss |
| Aquæ, | ℥iv m. |
S. To be applied twice a day, very carefully, to the full extent of the ulcerations and excoriations.
The cinchona here is not absolutely necessary; but operates by retaining the sulphate longer in contact with the edges of the gums.
Simple ulcerations and small gangrenes, as well as the troublesome excoriation, when not in the last stage, yielded promptly to this remedy; the good effect being generally visible from the first application.
Dr. Fox, my friend and fellow-labourer in the Asylum, had already taught me that it was important early to extract the teeth. I was not, however, sensible of the full extent of this rule, till after examining the fangs of some of them which were drawn. The separation of a portion of the periosteum from the fang, within the socket, which was universally found whenever the tooth was loose, among two or three hundred specimens, proved the existence of the disease in a deep, narrow crevice, into which it was impossible, by any contrivance, to insinuate the lotion. This cavity was laid open by extracting the tooth; and when the remedy was applied, the sanatory effect was surprisingly prompt. From this period, forwards, the universal rule was to extract all teeth, the moment they were discovered to be in the slightest degree loose; and "the blue wash" above described, became the standing remedy.