MEDICINE. 525

|3art OjtrU.

PERISCOPE.

MEDICINE.

MEMORANDUM ON THE USE OF BINIODIDE OF MERCURY, IN COMBINATION WITH THE RAYS OF THE SUN, FOR TIIE CURE OF GOITRE. BY F. J. MOUAT, M O., F.K.C.S., INSPECTOR OF JAILS AND DISPENSARIES, BENGAL.

In the districts about Motiharee, Segowlee, Bethiah, Bhagoha, and on to Goruckpore?indeed, along the whole line of the Teraie?the goitre is so pre- valent, that it can scarcely be an over-estimate to state, that, in many localities one individual in ten is afflicted with this horrible disorder.

In some cases, the tumour attains a certain size, and passes into a chronic state, without serious inconvenience to the person affected; in others, it increases rapidly, and, at the end of a few years, after becoming an enormous excrescence, terminates in loss of intellect in some cases, and in others in death.

In the cold weather of 1854-55, Captain Cunningham, second in command, 12th Irregular Cavalry, began to apply the biniodide to the goitre in the fol- lowing manner :? An ointment was prepared, according to a formula, as follows :? Melt 3 lbs. of lard or mutton suet, strain and clean; when nearly cool, add

9 drams of biniodide of mercury, taking care to make the powder fine by tri- turation in a mortar. Work in the mortar until no grains of red are apparent in the ointment, and

put in pots for use, taking care always to keep both powder and ointment from the rays of light.

Use as follows :?

About an hour after sunrise, apply the ointment to the goitre with a spatula made of ivory or thin broad smooth bamboo, quantity according to size of tumour; rub it well in for at least ten minutes. Let the patient then sit with his goitre held well up to the sun, and let him remain so, as long as he can endure it.

It is probable that, about noon, he will suffer severe pain from the blistering effect of the ointment, although no pustules are raised on the skin. About

2 p.m., the ointment should again be applied with a very careful and tender hand; and the patient should be dispatched to his home, with orders not to touch the ointment on any account with the hand, but to allow it to be gradu- ally absorbed, which absorption will be complete on the third day.

This treatment is quite sufficient for an ordinary cure. Should the case be

a very bad one, the patient is ordered to return next year, for the removal of what may remain of the tumour. Except in goitres of the very largest size, this is seldom necessary. After the application of the second year, no goitre has been known to continue.

The patients begin to come about the middle of November, and continue to

the end of March; after that time, the sun's rays act so violently on the medi-

cine, that it is not advisable to apply it. The cures effected have been very numerous. On my arrival at Segowlee, I

526 PERISCOPE.

was glad to join Captain Cunningham in this good work; but with him rests all the credit of having established it. The cases are not now so numerous as they were in 1855. At that time,

500 or 600 were not unfrequently treated in a single day; a small charge of 2 pice for each cure was levied for some time, in order to make the people set more value on it; but as this seemed to check some patients, it was discon- tinued.

Until lately, no exact account of the numbers treated has been kept; but, since Captain Cunningham commenced, up to the present time, it cannot have been less than 60,000. Many come from a very great distance?Goruckpore, Mozufferpore, Mulaye?but the cases in the vicinity are decidedly less nume- rous; in fact, the disorder is being extinguished. In no case, except one, have we failed to make a complete cure during the second year.

I am now on the point of departure for England, and I should be glad to think that the medicine might be continued to the people. I would propose that stations for its application should be established at Mozufferpore, at Moti- haree, at Segowlee, at Bethiah, at Rutawal or Bhogaha, at Ramnuggur, and at Goruckpore. To each station might be appointed a dresser, on rupees 8 per mensem, to apply the ointment, which should be furnished monthly from a central station. It would be proper to order, that the ointment be always applied in presence of the dresser. If given to be carried off, it will be sold. Nothing else on the subject strikes me at present; but cases have occurred when the patient rubbed off the medicine, when the smart became severe, and therefore the patients should be kept until sunset, after the stuff has been rubbed on. Any cooly can be taught to do it; all my servants apply it, and some of the troopers. A tender hand, and gentle use of the spatula, after softening the ointment by working up, is all that is needed.

Enclosed is the list of the cases treated since the commencement of the pre- sent year by me. Captain Cunningham has treated many hundred cases in addition to these, and, as I write, patients ai-e pouring into the compound.

Setting humanity aside, I think that, in a financial point of view, it would pay Government to get these poor people cured, for each life or each sound man must be worth at least one rupee per annum to the revenue.

It appears to me, that, the rays of the sun, either by some chemical action on the ointment, or by causing its more rapid absorption, have much to do with the cures effected; but I am about to make the experiment, of treating one man by night before a large fire, and comparing the case with one of a similar size and standing, treated in the usual way. By this means, I hope to ascertain how much of the cure depends on the

action of the sun's rays, whether as regards chemical properties or the absorb- ents of the skin.?Indian Annals of Medical Science, April 1857?