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g.c. wallich- cannabis indica

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.SJTI d S ) -ADICAE J O U1lVAL. [Jve 2 8 , .188. 1 r the latter conditiots. I t is well known that a t various times'| 0pilepsyr, idiocy, a n d some fqrms o f insanity, have been treated b y massage a n d gymnastics; but, fortunately, we now hear very little o f : such therapeutical aberrations. I t appears t o m e that diseases f t h e brain a n d spinal cord- must, !tQn account o f t h e anatomical situation o f these orgns, b e inacces- sible t o he influence of. massage, which c a n only b e applicable t o minoresuperficial parts o f t h e body. Apart from this, however, i t is ' Important t o coqisider 7that many o f t h e most important diseases' o t these organs a r e o f- a n inflammatory o r irritant character, either vpwimarily or secondaril y ; and this should. make it self-evident that wassage should n o t b e used: f or their treatment, even i f the suffering parts could b e reached b y i t . I w i i here only allude t o many forms of cerebral paralysis from hsmorrhage, embolism, a n d thrombosis, .which ar e followed b y sclerosing myelitis o f t h e pyramidal strands; a n d most forms o f primary lateral, posterior, o r insular sclerosis o f -the spinal cord. ' I t i s only charitable t o assume that t h e advocates o f massage, w h o -recommend their favourite procedure i n such a n d similar cases, ar e .Somewhat a t s e a with regard t o th e pathology a n d diagnosis o f d i s eases o f t h e nervous system. 1 : That which m a y be good f o r developing and strengthening healthy muscles, o r muscles which have been enfeebled b y disuse or certain Lopal morbid conditions, etc., is n ot f o r that reason suitable f o r t h e treatment o f muscular paralysis owing to central disease. I n most ases o f lateral a nd insular sclerosis, which are, unfortunately, n o w Limuch treated withmassage a n d exercises, rest . i s indicated rather than active exertion; a n d overstraining o f the-enfeebled muscles acts prejudicially o n t h e state o f t h e nervous centres.! I have recently seen quite a namber o f instances i n l which the central disease had} been rendered palpably worse b y procedures o f this kind; and, i n a case of cerebral paralysis which w a s some time ago under m y pare, the patient had, after four such sittings, been seized with col- lapse, which nearly carried h i m off. OCANNABIS INDICA. B Y G . C . WALLICH, M.D., Surgeon-Major, Retired- List. TH E following. facts, though bearing b u t indirectly upon those special medical uses of Indian hemp t o which attention h a s been drawn i n recent Issues o f t h e BRITISHa MEDIpgLJOURNAL, may, serve i n some measure t o explain t he conflicting estimate that have' been formed o f th e general value o f t h e drug byjjjffqrent observers. M1 y knowledge o f Indian hemp a s a therapeutic; agent dates from t h e yea,r 1838, ,when... its properties were commhunicated t o me - i n Calcutta by my friend D r . W.lB. O'Shaughnessy ;and,V Jrhis -request, I made t h e sketch o f t h q plant which is appeaded t o !his earliest memoir o n t h e subject. During my subseqgent- service i n . India, I ha d many opportunities o f testing t h e efflcacy o f jndian- heixp i n cases o f cholera, tetanus, hydrophobia, an d various minor disorders. But, though, fully convinced o f i t s value, like many other medical men, I soon became aware that t h e action o t h e drug w a s singu- larly uncertain, a n d that doses which i n o n e locality produced a given effect, frequently. failed toLproduce t h e same effect i n another.' Eventually i t became manifest that this uncertain action w a s due, t o inherent differences i n the composition o f t h e resinous extract o f : t h e plant, incident o n i t s being grown either i n the plains o r i n t h e hill-districts of. India. -The. drug bad, not, a t this periods been supplied o n indent t o military hospitals a t a distance from. t h e Ptesidency; a n d those-who.wanted t o . employ i t ezperimnentally i n their practice were, therefore,,obliged t o procure i t f o r -themselves from t he native drugAdealers, eitheriAn, t he form o f t he Acrde dried plant o r o f -the inspissated extractvwhidh.went b y t h e native name o f " churrus. , . , . . T h e fact which. came t o 'light was, that th e therapeutic efficacy. of the plant gr6wtiln t h e plains i s very markedly inferior-to that o f t h e plant pioduced-in.the~hill-districts. I hainsIn meansat- m y command o f ascertaining t he particular. conditions -of. soil, tbmpera- ture, a n d mode o f culture a n d preparation, upon. which ti.ssupe- riority of.the hill-plant i s dependeuit.; but i t is no w quite impossible t o doubt. thatitbe. a r e o f a n analogous kind t o those which, i; n a . major dere, cause t h e same .kpecies o f cannabis- t oo produde a highliy energetic ,medicinal ingredient i n tropical an d sub- tropical countries, Whilst. they exercise n o such effect upon - i t when grown }inonr own.tetbaperate latitudes. I T h e fact o f t h e superiority o f t h e extract a n d maxture prepaited Srom the hill-grown plant was, however, suggested to m y mind b y what h a d been communicated t o me in the years 1841 a n d 1842 b y .DrW. L . MacGregor, a t Jrnual, a station then notorious f o r i t s extreme unhealthiness, a n d visited, a t. t he peried refetred t o , b y consecutive outbreaks o f cholera i n i t s worst form, acute. dysentery, a n d enteric fever. Dr . MacGregor claimed t o have successfully-treated th e tw o first- named o f these formidable diseases b y suchi enorm-us doses o f hill-opium" a n d croton-oil that, I no t mysqlf wit- nessed the results, I should have hesitated t o vouhfor itheir authen- ticity. Fortunately, those w h o would like t o see-a formal record o f my friend's practice willfind it i n h i s work O Q . t h e t.Princirla Dis- eaeGs affecting Euroeyan an d Native Soldiers i n i t h e North- Western Province8 o f India, b y Surgeon W. L . MacGregor, MXD., published i n Calcutta in1843. Meanwhile, i t ma y interest t h e readers o f t h e JOURNAL to learn that i t w as not unusual with h j m t o give a s much as " fifteen drops o f croton-oil i n t h e course o; f twenty minutes, ornineteen drachms o f laudanum i n th e same -number o f successive hours, the doses o f croton-oil being occasionally increased t o twenty drops," without causing a n y untoward consequences MacGregor further states that "the smallest dose. o f opium given f o r sedative purposes i n hypercatharsis, wasfrom three t o s i x grains; whilst i n cholera i t w a s given t o a much greater extent." O n - the merits o r demerits o f this practice I have n o desire t o express a n y opinion; b u t o f this I still entertain a vivid lection (and what I state c a n easily b e confirmed b y other medical officers w ho were stationed a t Kurnal i n t h e years named), that many casts d i d unquestionably survire an d recover, if they d id not actually o w e their recovery t o -this supremely heroic treatment. Under a n y circumstances, i t must, I think, tend t o convince a l l w ho giVe the matter their serious thought, that there i s even y e t a good deal t o b e learned concerning the action o f some of the most powerful known drugs upon the human organism, when i t i s already under the fierce spell o f some form o f blood-poisoning. WOOLSORTERS' DISEASE. B y THOMAS WILMOT, L.R.C.P., M.R.C.S., Bradford. TH E interesting case came under m y observation. i. *ird, aged 4 1 , a "carder," worked f o r eight weeks on night-turn, u p t o t h e 12th o f H e ' w a s a ma n o f intemperate habits, bu t h a d -always h d veryrgood health u p to t h e time o f t h e present illness. H e w a s taken i l l about mid-day on Ma y 13th, b u t h a d n o rigor o r -vomiting. I w a s calledto s e e h im about 4 A.M. o n t h e 14th o f May, a n d found him.in t h e following condition. He w a s lying o n h i s right side, a n d breathing quickly, a nd com- plained o f being very. pborly a n d feeling a tightness across t h e chest; but h e hadno pain, a n d only a very slight cough ; h i s ears; hands, a n d feet were bluish a n d cold,.the skin k a s covered with a-cold clammy -perspiration; ;the temperature-was subnoimal i n t h e axillaund rectum. Th e tongue was covered with a thick yellow fur, and he h a d ' a great thirst o n him, w as almost pulseless, an d .i:& state o f collapse, a n d -was evidently i n a dying condition. Phbysical examination revealed a few. mucous rdles over t h e chest, b u t n o crepitation or dulness. I came t o the conclusion that the m a n w a s suffering t h e form o f blobd-poisbning.known: as-' 'waoolsorters' disease." Dr . Bell sa w the-patient'with m e about.1030 tixs t h e same day, a n d agreed with meain m y diagnosis. H e w a s then rapidly sinking, a n d died a n hour After our visit. 'Some' blood w a s taken from.'the back o f : t h e hand, which did n o t flow a t aol' freely; i t wa ' datk a n d stagnant. N o bacilli werefound in-the:blood'taken before death. ' H e lived about twenty'eight hours fronm t h e onset. I made apast mortcem examination fifty-four-hours after death,tIn -the presence o f D r , BelliE is bodyrwas fairly well nourished; there wana;. -slight discoloration a t .the upper part o the' thorax (but considring the> heat a t the'4ime; the body 'was i n a good state' o f preservation). There ware n o external marks o r bruises', Th e brain was:.klthy4 Qn w removing the' stetnum I found a gelatinous kind ' o f substanoesin anterior mediastinum, of a yellow colour. Clear fluidilowed freely from both' pleuraL cavities; t h e 'right contained bbtween three a n d four pints, the'.left t*eoor 'three pints. Th e right ':lung w a s oollawsed, a nd tr left w a s very slightly congested. "'There were-no igns inflammation i i ; either t h e -lungs o r t h e pleura. T h e pericardium w as fill o f clear fluid)i. On opening t h e 'heart, t h e caxities wete fbtud quite enipty, the valves were naturals; there w a s 'a:distinct'stainitg a n t h e left ventricle, which w a s continued into t h e aorta. Th e blood w as dark, a n d very fluid. :The.: trachea cnm- tained a little frothy mucus; there w a s n o enlargement of the

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Page 1: G.C. Wallich- Cannabis Indica

8/3/2019 G.C. Wallich- Cannabis Indica

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.SJTI d S )-ADICAE J O U 1 l V A L . [ J v e 2 8 ,. 1 8

1 r t h e l a t t e r c o n d i t i o t s . I t i s w e l l known t h a t a t v a r i o u s t i m e s ' |0 p i l e p s y r , i d i o c y , and s o m e f q r m s o f i n s a n i t y , h a v e b e e n t r e a t e d b ym a s s a g e a n d g y m n a s t i c s ; b u t , f o r t u n a t e l y , we n o w h e a r v e r y l i t t l eo f : s u c h t h e r a p e u t i c a l a b e r r a t i o n s .

I t a p p e a r s t o me t h a t d i s e a s e s o f t h e b r a i n and s p i n a l c o r d - m u s t ,! t Q n a c c o u n t o f t h e a n a t o m i c a l s i t u a t i o n o f t h e s e o r g n s , b e i n a c c e s -s i b l e t o t h e i n f l u e n c e o f . m a s s a g e , w h i c h c a n o n l y b e a p p l i c a b l e t om i n o r e s u p e r f i c i a l p a r t s o f t h e b o d y . A p a r t f r o m t h i s , h o w e v e r , i t i s 'I m p o r t a n t t o c o q i s i d e r 7 t h a t many o f t h e m o s t i m p o r t a n t d i s e a s e s 'o t t h e s e o r g a n s a r e o f - an i n f l a m m a t o r y o r i r r i t a n t c h a r a c t e r , e i t h e r

v p w i m a r i l y o r s e c o n d a r i l y ; a n d t h i s s h o u l d . make i t s e l f - e v i d e n t t h a tw a s s a g e s h o u l d n o t b e u s e d : f o r t h e i r t r e a t m e n t , e v e n i f t h e s u f f e r i n gp a r t s c o u l d b e r e a c h e d b y i t . I w i i h e r e o n l y a l l u d e t o many f o r m so f c e r e b r a l p a r a l y s i s f r o m h s m o r r h a g e , e m b o l i s m , a n d t h r o m b o s i s ,. w h i c h a r e f o l l o w e d b y s c l e r o s i n g m y e l i t i s o f t h e p y r a m i d a l s t r a n d s ;a n d m o s t f o r m s o f p r i m a r y l a t e r a l , p o s t e r i o r , o r i n s u l a r s c l e r o s i s o f

- t h e s p i n a l c o r d .' I t i s o n l y c h a r i t a b l e t o a s s u m e t h a t t h e a d v o c a t e s o f m a s s a g e , w h o

- r e c o m m e n d t h e i r f a v o u r i t e p r o c e d u r e i n s u c h a n d s i m i l a r c a s e s , a r e. S o m e w h a t a t s e a w i t h r e g a r d t o t h e p a t h o l o g y a n d d i a g n o s i s o f d i se a s e s o f t h e n e r v o u s s y s t e m .

1 : T h a t w h i c h m a y b e g o o d f o r d e v e l o p i n g a n d s t r e n g t h e n i n g h e a l t h ym u s c l e s , o r m u s c l e s w h i c h h a v e b e e n e n f e e b l e d b y d i s u s e o r c e r t a i nL o p a l m o r b i d c o n d i t i o n s , e t c . , i s n o t f o r t h a t r e a s o n s u i t a b l e f o r t h et r e a t m e n t o f m u s c u l a r p a r a l y s i s o w i n g t o c e n t r a l d i s e a s e . I n m o s ta s e s o f l a t e r a l a n d i n s u l a r s c l e r o s i s , w h i c h a r e , u n f o r t u n a t e l y , now

L i m u c h t r e a t e d w i t h m a s s a g e a n d e x e r c i s e s , r e s t . i s i n d i c a t e d r a t h e rt h a n a c t i v e e x e r t i o n ; a n d o v e r s t r a i n i n g o f t h e - e n f e e b l e d m u s c l e sa c t s

p r e j u d i c i a l l yo n t h e s t a t e o f t h e n e r v o u s

c e n t r e s . !I h a v e

r e c e n t l ys e e n q u i t e a n a m b e r o f i n s t a n c e s i n l w h i c h t h e c e n t r a l d i s e a s e h a d }b e e n r e n d e r e d p a l p a b l y w o r s e b y p r o c e d u r e s o f t h i s k i n d ; a n d , i na c a s e o f c e r e b r a l p a r a l y s i s w h i c h w a s s o m e t i m e a g o u n d e r myp a r e , t h e p a t i e n t h a d , a f t e r f o u r s u c h s i t t i n g s , b e e n s e i z e d w i t h c o l -l a p s e , w h i c h n e a r l y c a r r i e d him o f f .

OCANNABIS INDICA.

BY G . C . WALLICH, M . D . , S u r g e o n - M a j o r , R e t i r e d - L i s t .

TH E f o l l o w i n g . f a c t s , t h o u g h b e a r i n g b u t i n d i r e c t l y u p o n t h o s es p e c i a l m e d i c a l u s e s o f I n d i a n hemp t o w h i c h a t t e n t i o n h a s b e e nd r a w n i n r e c e n t I s s u e s o f t h e B R I T I S H a M E D I p g L J O U R N A L , m a y ,s e r v e i n s o m e m e a s u r e t o e x p l a i n t h e c o n f l i c t i n g e s t i m a t e t h a t h a v e 'b e e n f o r m e d o f t h e g e n e r a l v a l u e o f t h e d r u g b y j j j f f q r e n t o b s e r v e r s .

M 1 y k n o w l e d g e o f I n d i a n h e m p a s a t h e r a p e u t i c ; a g e n t d a t e s f r o mt h e y e a , r 1 8 3 8 , , w h e n . . . i t s p r o p e r t i e s w e r e c o m m h u n i c a t e d t o me - i nC a l c u t t a b y my f r i e n d D r . W . l B . O ' S h a u g h n e s s y ; a n d , V J r h i s - r e q u e s t , Imade t h e s k e t c h o f t h q p l a n t w h i c h i s a p p e a d e d t o ! h i s e a r l i e s tm e m o i r o n t h e s u b j e c t . D u r i n g my s u b s e q g e n t - s e r v i c e i n . I n d i a , Ih a d many o p p o r t u n i t i e s o f t e s t i n g t h e e f f l c a c y o f j n d i a n - h e i x p i nc a s e s o f c h o l e r a , t e t a n u s , h y d r o p h o b i a , a n d v a r i o u s m i n o r d i s o r d e r s .B u t , t h o u g h , f u l l y c o n v i n c e d o f i t s v a l u e , l i k e many o t h e r m e d i c a lm e n , I s o o n b e c a m e a w a r e t h a t t h e a c t i o n o f t h e d r u g w a s s i n g u -l a r l y u n c e r t a i n , a n d t h a t d o s e s w h i c h i n o n e l o c a l i t y p r o d u c e d ag i v e n e f f e c t , f r e q u e n t l y . f a i l e d t o L p r o d u c e t h e s a m e e f f e c t i n a n o t h e r . 'E v e n t u a l l y i t b e c a m e m a n i f e s t t h a t t h i s u n c e r t a i n a c t i o n wa s d u e ,t o i n h e r e n t d i f f e r e n c e s i n t h e c o m p o s i t i o n o f t h e r e s i n o u s e x t r a c t o f :t h e p l a n t , i n c i d e n t o n i t s b e i n g g r o w n e i t h e r i n t h e p l a i n s o r i n t h eh i l l - d i s t r i c t s o f . I n d i a . - T h e . d r u g b a d , n o t , a t t h i s p e r i o d s b e e ns u p p l i e d o n i n d e n t t o m i l i t a r y h o s p i t a l s a t a d i s t a n c e f r o m . t h eP t e s i d e n c y ; a n d t h o s e - w h o . w a n t e d t o . e m p l o y i t e z p e r i m n e n t a l l y i nt h e i r p r a c t i c e w e r e , t h e r e f o r e , , o b l i g e d t o p r o c u r e i t f o r - t h e m s e l v e sf r o m t h e n a t i v e d r u g A d e a l e r s , e i t h e r i A n , t h e f o r m o f t h e A c r d e d r i e dp l a n t o r o f - t h e i n s p i s s a t e d e x t r a c t v w h i d h . w e n t b y t h e n a t i v e n a m eo f " c h u r r u s . , .,. .

T h e f a c t w h i c h . c a m e t o ' l i g h t w a s , t h a t t h e t h e r a p e u t i c e f f i c a c y .o f t h e p l a n t g r 6 w t i l n t h e p l a i n s i s v e r y m a r k e d l y i n f e r i o r - t o t h a t o ft h e p l a n t when p i o d u c e d - i n . t h e ~ h i l l - d i s t r i c t s . I h a i n s I n m e a n s a t - mycommand o f a s c e r t a i n i n g t h e p a r t i c u l a r . c o n d i t i o n s - o f . s o i l , t b m p e r a -t u r e , a n d mode o f c u l t u r e a n d p r e p a r a t i o n , u p o n . w h i c h t i . s s u p e -r i o r i t y o f . t h e h i l l - p l a n t i s d e p e n d e u i t . ; b u t i t i s n ow q u i t e i m p o s s i b l et o d o u b t . t h a t i t b e . c o n d i t i o n s a r e o f an a n a l o g o u s k i n d t o t h o s ew h i c h , i ; n a . m a j o r dere, c a u s e t h e s a m e . k p e c i e s o f c a n n a b i s - t o op r o d u d e a h i g h l i y e n e r g e t i c , m e d i c i n a l i n g r e d i e n t i n t r o p i c a l a n d s u b -t r o p i c a l c o u n t r i e s , W h i l s t . t h e y e x e r c i s e n o s u c h e f f e c t u p o n - i t wheng r o w n } i n o n r o w n . t e t b a p e r a t e l a t i t u d e s . I

T h e f a c t o f t h e s u p e r i o r i t y o f t h e e x t r a c t a n d m a x t u r e p r e p a i t e dS r o m t h e h i l l - g r o w n p l a n t w a s , h o w e v e r , s u g g e s t e d t o my m i n d b y

w h a t h a d b e e n c o m m u n i c a t e d t o me i n t h e y e a r s 1 8 4 1 and 1 8

. D r W . L . M a c G r e g o r , a t J r n u a l , a s t a t i o n t h e n n o t o r i o u s f

e x t r e m e u n h e a l t h i n e s s , and v i s i t e d , a t . t h e p e r i e d r e f e t r e d tc o n s e c u t i v e o u t b r e a k s o f c h o l e r a i n i t s w o r s t f o r m , a c u t e . d y s e na n d e n t e r i c f e v e r .D r . M a c G r e g o r c l a i m e d t o h a v e s u c c e s s f u l l y - t r e a t e d t h e two

named o f t h e s e f o r m i d a b l e d i s e a s e s b y s u c h i e n o r m - u s d o s

h i l l - o p i u m " a n d c r o t o n - o i l c o m b i n e d , t h a t , 1 a d I n o t m y s q l fn es s e d t h e r e s u l t s , I s h o u l d h a v e h e s i t a t e d t o v o u h f o r i t h e i r a ut i c i t y . F o r t u n a t e l y , t h o s e wh o w o u l d l i k e t o s e e - a f o r m a l r e c

my f r i e n d ' s p r a c t i c e w i l l f i n d i t i n h i s w o r k O Q . t h e t . P r i n c i r l ae a e G s a f f e c t i n g E u r o e y a n a n d N a t i v e S o l d i e r s i n i t h e N o r t h - W eP r o v i n c e 8 o f I n d i a , b y S u r g e o n W. L . M a c G r e g o r , M X D . , p u b l

i n C a l c u t t a i n 1 8 4 3 . M e a n w h i l e , i t ma y i n t e r e s t t h e r e a d e r s o

JOURNAL t o l e a r n t h a t i t w a s n o t u n u s u a l w i t h hjm t o g imuch a s " f i f t e e n d r o p s o f c r o t o n - o i l i n t h e c o u r s e o ; f t w e n t y m i no r n i ne t e e n d r a c h m s o f l a u d a n u m i n t h e s a m e - n u m b e r o f s u c c eh o u r s , t h e d o s e s o f c r o t o n - o i l b e i n g o c c a s io n a l l y i n c r e a se d t o td r o p s , " w i t h o u t c a u s i n g a n y u n t o w a r d c o n s e q u e n c e s w h a t e v e r .

M a c G r e g o r f u r t h e r s t a t e s t h a t " t h e s m a l l e s t d o s e . o f o p i u mf o r s e d a t i v e p u r p o s e s i n h y p e r c a t h a r s i s , w a s f r o m t h r e e t o s i x g rw h i l s t i n c h o l e r a i t w a s g i v e n t o a much g r e a t e r e x t e n t . "

O n - t h e m e r i t s o r d e m e r i t s o f t h i s p r a c t i c e I h a v e n o d e se x p r e s s a n y o p i n i o n ; b u t o f t h i s f a c t I s t i l l e n t e r t a i n a v i v i dl e c t i o n ( a n d w h a t I s t a t e c a n e a s i l y b e c o n f i r m e d b y o t h e r m e

o f f i c e r s who w e r e s t a t i o n e d a t K u r n a l i n t h e y e a r s n a m e d )many c a s t s d i d u n q u e s t i o n a b l y s u r v i r e a n d r e c o v e r , i f t h e y d i

a c t u a l l y owe t h e i r r e c o v e r y t o - t h i s s u p r e m e l y h e ro i c t r e a t

U n d e r a n y c i r c u m s t a n c e s , i t m u s t , I t h i n k , t e n dt o

c o n v i n c e a lg i V e t h e m a t t e r t h e i r s e r i o u s t h o u g h t , t h a t t h e r e i s e v e n y e t ad e a l t o be l e a r n e d c o n c e r n i n g t h e a c t i o n o f some o f t h e

p o w e r f u l known d r u g s u p o n t h e human o r g a n i s m , when i t i s a lu n d e r t h e f i e r c e s p e l l o f some f o r m o f b l o o d - p o i s o n i n g .

WOOLSORTERS' DISEASE.

By THOMAS WILMOT, L . R . C . P . , M . R . C . S . , B r a d f o r d .

TH E 0 o l l o w i n g i n t e r e s t i n g c a s e c a m e u n d e r my o b s e r v a t i o n .* i r d , a g e d 4 1 , a " c a r d e r , " w o r k e d f o r e i g h t w e e k s o n n i g h t - t u r

t o t h e 1 2 t h o f M a y . H e ' w a s a ma n o f i n t e m p e r a t e h a b i t s , b u

- a l w a y s h a d v e r y r g o o d h e a l t h u p t o t h e t i m e o f t h e p r e s e n t i lHe w a s t a k e n i l l a b o u t m i d - d a y o n Ma y 1 3 t h , b u t h a d n o r i g

- v o m i t i n g . I w a s c a l l e d t o s e e him a b o u t 4 A . M . o n t h e 1 4 t h o fa n d f o u n d h i m . i n t h e f o l l o w i n g c o n d i t i o n .

He w a s l y i n g o n h i s r i g h t s i d e , a n d b r e a t h i n g q u i c k l y , a n dp l a i n e d o f b e i n g v e r y . p b o r l y a n d f e e l i n g a t i g h t n e s s a c r o s s t h e cb u t h e h a d n o p a i n , and o n l y a v e r y s l i g h t c o u g h ; h i s e a r s ; h a n d sf e e t w e r e b l u i s h and c o l d , . t h e s k i n k a s c o v e r e d w i t h a - c o l d cl

- p e r s p i r a t i o n ;; t h e t e m p e r a t u r e - w a s s u b n o i m a l i n t h e a x i l l a u n d r eTh e t o n g u e was c o v e r e d w i t h a t h i c k y e l l o w f u r , a n d h e had ' at h i r s t o n h i m , was a l m o s t p u l s e l e s s , and . i : & s t a t e o f c o l l a p s e- w a s e v i d e n t l y i n a d y i n g c o n d i t i o n . P h b y s i c a l e x a m i n a t i o n r e v e

f e w . mucous r d l e s o v e r t h e c h e s t , b u t no c r e p i t a t i o n o r d u l ne s s .I came t o t h e c o n c l us i o n t h a t t h e ma n was s u f f e r i n g f r o m - t h e

o f b l o b d - p o i s b n i n g . k n o w n : a s - ' ' w a o o l s o r t e r s ' d i s e a s e . " D r . B e l

t h e - p a t i e n t ' w i t h me a b o u t . 1 0 3 0 t i x s t h e same d a y , a n d a g r e e dm e a i n my d i a g n o s i s . He w a s t h e n r a p i d l y s i n k i n g , a n d d i e d a nA f t e r o u r v i s i t . ' S o m e ' b l o o d w a s t a k e n f r o m . ' t h e b a c k o f : t h ew h i c h d i d n o t f l o w a t a o l ' f r e e l y ; i t wa' d a t k a n d s t a g n a n t .b a c i l l i w e r e f o u n d i n - t h e : b l o o d ' t a k e n b e f o r e d e a t h . ' H e l i v e dt w e n t y ' e i g h t h o u r s f r o n m t h e o n s e t .

I made a p a s t m o r t c e m e x a m i n a t i o n f i f t y - f o u r - h o u r s a f t e r d e a t- t h e p r e s e n c e o f D r , Belli Ei s b o d yr w a s f a i r l y w e l l n o u r i s h e d ;

w a n a ; . - s l i g h t d i s c o l o r a t i o n a t . t h e u p p e r p a r t o t h e ' t h o r a xc o n s i d r i n g t h e > h e a t a t t h e ' 4 i m e ; t h e b o d y ' w a s i n a g o o d s t ap r e s e r v a t i o n ) . T h e r e w a r e n o e x t e r n a l m a r k s o r b r u i s e s ' , T h ew a s : . k l t h y 4 Qnwr e m o v i n g t h e ' s t e t n u m I f o u n d a g e l a t i n o u s' o f s u b s t a n o e s i n a n t e r i o r m e d i a s t i n u m , o f a y e l l o w c o l o u r .f l u i d i l o w e d f r e e l y f r o m b o t h ' p l e u r a L c a v i t i e s ; t h e ' r i g h t c o n tb b t w e e n t h r e e and f o u r p i n t s , t h e ' . l e f t t * e o o r ' t h r e e p i n t s . Th e

' : l u n g was o o l l a w s e d , a n d tr l e f t was v e r y s l i g h t l y c o n g e s t e d . " 'w e r e - n o i g n s " o f i n f l a m m a t i o n i i ; e i t h e r t h e - l u n g s o r t h e p lT h e p e r i c a r d i u m was f i l l o f c l e a r f l u i d ) i . O n o p e n i n g t h e ' h e a r tc a x i t i e s w e t e f b t u d q u i t e e n i p t y , t h e v a l v e s were n a t u r a l s ; t h e r

' a : d i s t i n c t ' s t a i n i t g a n t h e l e f t v e n t r i c l e , w h i c h was c o n t i n u e dt h e a o r t a . Th e b l o o d was d a r k , and v e r y f l u i d . : T h e . : t r a c h e a

t a i n e d a l i t t l e f r o t h y m u c u s ; t h e r e was no e n l a r g e m e n t o f


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