It is at all times a dangerous boast for a physician to make, to say that, in the treatment of any complaint, he has always succeeded. He is frequently not credited; and he can never know at what moment disbelief may be borne out by his subsequent failures. A faithful adherence to fact, and justice to the medical art, oblige me to say that it was owing to the observation of these means, that I never had an opportunity of making a dissection, after the one mentioned in a preceding page. Upwards of 120 ulcerated gums came under my notice in the course of three months; of which 70 were affected at one time. Of these, by far the greater number would, unquestionably, have escaped gangrene. The experience of past winters, however, and that of the preceding autumn, justifies the belief that there would have been several gangrenous cases, and some deaths; unless interrupted by remedial means. Some 3 or 4 suffered small spots of mortification, and one, by the delay arising from the tardy report of a nurse, suffered necrosis in a portion of an alveolus; but they were speedily arrested, and the production of more such cases, I believe, prevented, by the employment of the above means.
I have been once, since then, called in consultation to a case in which this remedy failed; but this was only two days previous to death, and during the existence of swelled cheek, and of a thick gangrenous eschar, and it was in fact only once imperfectly applied.
The farthest advanced of all the cases which I have seen, since that time, relieved by this remedy, was in the practice of my friend, Dr. R. M. Huston. He aided it by the application of a poultice with lead-water to the external surface of the cheek. This was thought to be productive of much relief.
Great attention and care are requisite on the part of the physician, to see that every part of the ulceration and excoriation is made visible, and brought under the influence of the applications employed. Without this entire knowledge of the extent of the evil, the result will be failure. The disgusting sloughs and discharge, and the fear of an imaginary contagion, make the nurses very unwilling to introduce their fingers into the reluctant little patient's mouth, and without this scrutiny all is in vain. The physician is compelled to set the example, to try the looseness of the teeth with his own fingers, and to ensure the nurse's entire knowledge of the extent of the disease.
Dr. Beesley writes that the women in his neighbourhood, frequently used considerable roughness in applying the lotions. Certainty is absolutely necessary.
After the remedy had been thus accidentally discovered in the Asylum, and used for a few days, I received Dr. Beesley's letter mentioned above; and I then learned that the sulphate of copper was the principal dependence of the physicians at Salem. As, however, I had never seen Dr. Vanmeter's thesis, the use of it at the Asylum was new to me.
An excellent remedy, and one on which the sole dependence should be placed, were we not in possession of one which possesses a decided superiority, is one which was communicated to me by Dr. Parrish. It is as follows, including a slight correction made by the apothecary:
| R. Sulph. Zinci, | ℨi |
| Aquæ, | ℨij Solve. |
| Dein adde, Mellis Despum. et Tinct. Myrrhæ, aa | ℥ij |
To be used in the manner described above. Some bad cases yielded to the following:
| R. Sulph. Zinci, | ℨij |
| Aquæ, | ℥i m. |