IMAGE EVALUATION TEST TARGET (MT-3) .^^ 4i£». 1.0 I.I ■50 """^ HRas 1^ 1^ u Hii 12.0 12.2 1.8 L25 i 1.4 m V n terminant par !a dernidre page qui comporte une telle empreinte. Un des symboles suivants appara?tra sur la derniAre image da cheque microfiche, selon le cas: la symboie -^ signifie "A SUiVRE ". ie symbols V signifie "FIN". Les cartes, pidnches. tableaux, etc.. peuvent Atre filmAs k des taux de reduction diffirents. Lorsque le document est trop grand pour Atre reproduit en un seul clichA. il est film* A partir de i'angia supArieur gauche, de gauche A droite. et de haut en bes, en prenant ie nombre d'images nAcessaire. Les diagrammes suivants iilustient la mAthoda. 1 2 3 1 2 3 4 5 6 liyo Ci ».-. • li; ' 'i- PAPE R i'Rkparp:d to be rkad at the ANNUAL MEETING '\ -UK THK— x^ y Canada B|edical J^ggocialion, HELD AT BANFF, Tuesday and Wednesday, August 13 & 14th. l f BY A. JUKES, M,D , Vice-President for the Northwest Territories for 1889, HUT NOT HEAD ON THAT OCCASION. SUPPLEMENT TO THE " NORTHERN LANCET, ' JANUARY, 1880. t?^ \VlNNIPB« : I'RINTKD AT THK OKKICE OF TliE NoKTItKKX LaNCKT, 4 JaMKSSt. EaHT. lE*f^lc\tcyiryr jVote, Thk t..llowin,K paj-^'f ..!-, - The Endemic Fever of the Northwest Territoi-ies • was prepared by lue as Vice-Piesident of the "Canada Medieal Association " for tlie Teriitoi'ies referred to, to be read at the Annual Meeting of the Association, held at Banff, on the 12th and i:{th of Au,uust. iSMit. .My name and paper appearing first, both on the list published in the - Canada Lancet'" and on the Programme shown nie on the Hrst day of the meeting at Banff. I'crhapx throu^di some misunderstanding, but rertainly «rithout my knowledge until late ou the hist day of the meeting, when it became kn(»wi\ to n.e accidentally, my name and paper were transferred from the top to the bottom of the list, on discovering which, T withdraw them. A. JUKES. BKdiXA, Dec. -If, I88'.i. ipj^f:ei:ei ortliwest ' Canada d at the 2th and both on ogramine hout my } became red from withdraw JKES. I'llKI'ARElJ TO UK IlKAD AT THK A ::v IV I T A. ly ivx 13: 13: 'r I IV o OK I UK OAIViVOA AdEjOIOALv A.»S<>OI ATIOTV Held at BduHT, August LS and It, l.SS'J, By A.JCKKS. M.I)., V'lrc-l'iWKlont for tlw Norf/nvf^sf Territoriei^ for /SSf). Kut no/ riail on fhn/ orrn.iioii. Mr. President and GanUenien : — As Vice-President of the Canadian Medical Assdciation for the Northwest Territories, and more especially for that portion of tlieiu com- prising the three great Districts of Assiniboia, Alberta and Saskatchewan, extensive and widely separated regions which T lia\>' \ isited on many occasions, and in some of which 1 ha\e for 'ai'ious p( riods resided during the last seven years and more ; 1 have thought it might intei-est some of those present, to whom nmch relating to these Territories may be (!om- paratively unknown, to hear from one who lias enjoyed gi'eater opportuni- ties for acquiring such knowledge, what he has learned respecting, - 1st. The Indigenous diseases to which tlie aborigines were subject in their natural primitive condition. 2nd. The Cotitagious Zymotic diseases from which they have suffered so disastrously at the hands of their invaders ; and third, The Hndemic dis- eases, with which we who have entered into and taken possession of their inheritance, have now, and will hereafter, increasingly have to contend. During the years i-eferred to, I ha\e as many of you probably know, occupied the position of Senior Surgeon of the N. W. M. Police, a force numbering 1,000 men, detachments of which, many of them large, are now and have been for many years, stationed in almost every part of the Territories lying south of the Great Saskatchewan, and latterly to some extent, in the Province of British Columbia also; that is roughly speaking, over an expanse of country extending from Banff, where we now stand, somewhere in the neighborhood of the 116th Meridian of West longitude, to the Western boundary of Manitoba, upwards of 700 miles to the East- ward ; and from Fort Saskatchewan on the gi-eat Northern I'iver of that name, in about 54 degrees of North latitude, to the International Boundary — 4- linc. noverlii<; nearly five degi'etis of liitituv«>ries. even utter woiimls of tiie most iippuliinf^ nutufe. These reuiark.^ though still substantially true, apply i. ore directly to a period antecedent to theii" complete suppression and di'gradation, l)y what with grim irony. goes by the name of "(.'ivilization. " At present as a race, too many of thenj, more especially the feeble remnant, not exceeding 7,000 in number, of the (ince proud and powerful tril)esof the Blackfeet, liloods and Peigans. now known as the Blackftiot Confedei-aey, established along j)ortions of the garded "Old Mail's, the "How'" and the "Helly" tiveis, fioui one to two hundred and mt mile« southeastward of where we are now assembled; have long been so debauched and degraded by intercourse with Europeans, wherever in thecoursc of their wanderings they have been bi-ought into close relations with them ; and so universally contaminated with syphilitic disease in every conceiva ble form, manifesting itself as f have too often noticed throughout entire families, in scrofulous atiections, cleiirly complicated with, if not wholly dependent upon hereditary Syphilis; that it is now dilHcult if not impos sible to Hnd any among them altogether free from such constitutional pol lution and defilement. [n their normal condition, living a wandering life in the open air, thf boundless sky above them, the boundless plains l)elow, they enjoyed a re- tempers markable exemption from acute idiopathic inflammatory affections of the durino' , parenchymatous structures and serous membranes, which we who have The i supplanted them in their ancient hoaie.«, still continue to enjoy. During present, upwards of nearly eight years spent in active proiessional work in various quired i parts of these Territories, exercising medical supervision over a large states o number of comparatively unacdimated men, whose duties often subjected bttt pre them to more than ordinary exposure ; I have never during that period, elevatec seen a single case of Idiopathic Pneumonia, Pleuritis, or Peritonitis materia though owing to causes hereafter to be referred to, painful neuralgic prepare( affections, too often mistaken by the careless and inexperienced for these viiled i graver forms of disease, are not uncommon. of those In looking back recently over the Monthly Sick Reports for severa. eftent) years past, 1 find only one case of Pneumonia recorded ; and this solitary fin a i case occurred in a division stationed in the Kootenay Valley in Britisli B|r. Wi Columbia, 120 miles south of this hotel, ("Banff,") during December, 1887 characte It is true that we now find among the Indians in their present de-^raded tte oOtl and dependent condition ; and more especially during youth and adoles Mpilaria cence, chronic pulmonary affections in some respects resembling Phthisis Hies ; t but the ultimate conviction impressed upon my mind has hitherto been bjF thes* that tliese are but the too common manifestations of a pseudo-scrofulou; 'Oa mu( form of disease, originating; in the fatal and universal contamination o: tfcit is, their progenitors, to which I have already referred. I have in my pos viries sc session records written by men of great intelligence, going back 125 yean ^6o far and more, who from personal intercourse with the primitive races o olOntai these plains, were familiar with their true condition, before they becaiii- y gradually Northwest ; these remote )ut the broad embouchure temperature The signific- ent when it ,t Slave Lake it Qu'Appelle trees, that is VAu river and e and a half Iflalaria under It might reasonably be conjectured that ou reaching the elevation at- tained l)y the rolling; prairie at the foot of the einterik slope of the Rocky Mountains, (some 4,000 feet) we raij^ht with a light iieart, bid our hitherto omnipresent enemy good-bye, and that still further weatward, on thread- ing their dark and deep detiles, we should once more breathe freely, under the strong conviction that here at last, we were safely beyond its influence ; but it is only too true, as all past and present experience proves, that in many of the gloomy gorges and deep, humid valleys of these mountains, a severe and fatal form of nialarial remittent, commonly known throughout these regions as "Mountain Fever," prevails more or less extensively in Autumn, when high ranges of temperature have long continued, resembling very closely that occurring upon the plains. This may be accounted for by the fact that very large areas on both flanks of these mountains, ex- tending very far within them, and constituting in British America, between the 49th and 5r)th parallels of north latitude, four fifths of the whole mountain range are composed, almost exclusively, of carboniferous lime stone and Devonian strata, embracing ih iieir depressions considerable areas of the same tertiary and cretaceous for; nations, which, as already shown, constitute so wide a surface of the great plains lying to the east- ward of them and which have appar , :ly been lifted up by these moun- f?i^>, in their ascent, and when in addition Lo this it is pointed out that the bottoms of these mountain chasms are ''lied to a great depth with vast accumulation i of decayed vegetation and calcareous debris, washed down during unnumbered centuries from the surrounding mountain sides, it will no longer seem strange to those who are capable of approciating the significance of these facts, that under such conditions, unacclimated miners and others temporarily inhabiting these valleys during the Autumn months, when great fluctuations of temperature occur during every 24 hours, should not unfrequently suffer from Malarial Fever of a very severe and fatal character. We lost several men of the Division temporarily j stationed in the Kootenay Valley, about 100 miles south of this place, (Banff,) from a fatal ha-morvhagic form of this endemic fever in the Autumn of 1887, and might probably have lost our/ Assistant Surgeon, also [but for the prompt and efficient services rendered by Dr. Powell, 'Superintendent of Indian Affairs in British Columbia at that critical ; period. The whole subject of Malaria, and indeed the greater subject of the "germ" origin of disease, of which this is but a part ; though consider- able accessions to our knowledge have recently been achieved, is one which is still, to a great extent, shrc it as that these soils %t moss is lot contain lopment in sideration. I of a v*>ry cl cau only nee of this south-west- uple inter- liflFerent, a b instances greatly in- mineral or estions not nonstrated. .t to sea or al marshes, 1 subjected he volcanic ;3 of iron in ; Kong and eir in t'' rise iterial com- lal% which >U8 country )cked lakes, ! of square soda, prob- ises, which, by fire over ingredients id too often 3 salubrious t in regions is no single -f its malefic ,nd autumn [an peninBula, iBftlubritj'." We have few other independent diseases here ; malaria, like other despotic powers, tolerating no rival in its own imperial donmins, wherein it practically reigns supreme : impressing its own marked characteristics upon, and materially modifying, every other form of disease intruding temporarily within the limits of its empire, and compelling all, so long as they remain, in the words of Sydenham, to " wear itn livery." In concluding this paper, I had not originally intended to otter any suggestions respecting the method of treatment which T have found most successful in the management of the Endemic Fever to which I have referred as occurring so universally throughout the northwest plains, during seasons favorable to its development, from the North Saskatchewan to the International Boundary Line, and from the valleys of the Rocky Mountains to Winnipeg, and probably far beyond these limits, more es- pecially along the courses of the great river valleys, in autumn, after preternaturally hot and dry summers, when vast expanses of muddy flats are laid bare and exposed to the scorching sun of July, August and September; but since completing this paper as originally written, I have been induced by the advice of others to add a few words on this matter. Let it be first clearly understood that under various local appellations conff-rred upon it in the diverse regions over which it prevails, whether as ^mountain fever" in the valleys of the Rockies; as " Saskatchewan fever » along the great rivers of that name; as " Red River fever " throughout that portion of Manitoba watered by the " Red River of the North " ; or as "Typhoid fever," too common in Winnipeg at the present day, which has unquestionably a similar origin (though modified to some extent by local influences abounding more or less in all great and growing cities); the true source and governing influence of the wide-spread and fatal disease, hitherto generally referred to under these diverse appellations, is In all cases one and the same; having everywhere a common origin, thou<»h occasionally modified by conditions locally prevailing, and requiring for its successful management and treatment a clear recognition of this im- |k)rtant fact, : i The general course of treatment to which I now propose to refer did not originate with me, nor indeed in these Territories at all; is is a modification %l the treatment found most successful and ultimately adopted by the Itaedical officers of the Army of the Potomac in the swamps of the ilhicahominy, during the great American Rebellion of 1863; long before lRle true Germ-origin of Malarial Fever was known, or even suspected lUve by a few; and which has since been found equally applicable to, and %ttcces8ful in the treatment, under all climates, of cases of fever clearly Iraceable to a malarious origin; the true rationale of which has now been sndered clear, by recent revelations respecting the physiological action of inchona and its salts upon the microbe to whose presence malarial fever "due, their specific action as direct Germicide«t con^tvaxng in the most -14— emphatic manner our contidence in their etlicacy in the treatment of malarious diseases. This fever, throughout the whole Northwest, so far as observed by me, is rarely a pure intermittent, but always of a severe remittent type; the nearest approach to an intermission occurring ordinarily during the first twenty-four hours, after which, if unattended or unscientifically treated, the fever frequently assumes a severe remittent character, which may well be mistaken for a continued fever, unless the clinical thermometer is assiduously and intelligently used and the temperature regularly recorded, when distinct remissions, occurring most frequently between five and eight in the morning, will be apparent; but if mismanaged, it will pass in the course of a few days into continued fever, often of a low typhoid type,* over which medicine exercises little appreciable control ; the special symp- toms characterising which, whether of an Asthenic, Hsemorrhagic or Comatose character, will vary much in different years. During the first fourteen or twenty-one days, wherein alone we can hope successfully to limit its duration, the same uniform treatment will be generally applicable, and will, if faithfully and intelligently carried out rnd persisted in, prove efficient in the vast majority of cases. I have seen a good deal of malarial fever during the last forty years, and for the last eight have been familiar with it as it manifests itself in these Territories; during this latter period I have never lost a case which I attended per- sonally from the beginning of the disease, and very few, where the course of treament suggested by me was adopted and intelligently persisted in by others, even after ten days had elapsed since its inception. The first and most important step in the management of this fever, is to ascertain at what period in each twenty-four hours the temperature touches its lowest point; that is, at what hour we may hereafter expect the remission to occur. This, in five out of six cases, will be between five and eight o'clock a.m. A temperature chart should be immediately pre- pared, and the temperature during the first twenty-four hours should be carefully taken every two hours and recorded thereon ; and, when it is falling, should be taken every half hour, and recorded, until the exact time in each twenty-four hours when it touches the lowest point is registered. Ar regards internal treatment, if the case is seen early, I sometimr , bejfin by giving a scruple of ipecacuanha as an emetic, and as soon as this has ceased to operate I give one drachm of compound tincture of cinchona with ten minims of dilute nitric acid in sufficient water, no matter how high the temperature may be, and continue this every three or four hours, day and night, according to the severity of the case, givins; at the same I * Due uu(iueBtionably, as has been clearly demonstrated by Tomtnasi, to " f^ecro- hiosis of the red corpuscles of the blood," literally death of the life-blood by the destiuctive agency of the parasite. This amceboid parasite has since been dearly demontitrated by Laveran and others. r tment of id by me, type; the ; the first y treated, may well ometer is recorded, and eight ass in the old type,* cial symp- rrhagic or e can hope nt will be sarried out [ have seen or the last Territories; lended per- the course sisted in by [lis fever, is temperature r expect the letween five adiately pve- 9 should be d, when it i-s e exact time registered. I sometime j soon as this of cinchona matter how [* four hours, at the same li, to " Kecro- (•blood by the ) been clearly —15— time as nourishment equal parts of milk and water in such quantities as the patient will take it, and water or toast water ad libitum, to allay thirst. If the tongue becomes brown and dry, I paint it frequently with glycerine, laid on with a large camel hair pencil. In the majority of cases seen early, if this treatment is persistently and intelligently carried out, an intermission will occur {generally between five and eight a.m.), within the first seven days, when ten grains of quinine should be instantly ad ■ ministered (as it may last but half an hour), and repeated at the end of an hour if the temperature has not increased. Several ten-grain powders of quinine should be left with the nurse or other competent attendant, with definite instructions, when and under what conditions, they are to be administered; unless (which is far better) the physiciaa can be with the patient at the t'me the intermission is eKpected. The opportunities afforded will not be many, and if these are lost, the patient may go on for five or six weeks, to a tedious recovery, or death. Should the temperature rise above 99 degrees after the first ten grains of quinine are administered, the cinchona mixture must be continued every three hours as before, until the temperature again touches 99 degrees or below, Whenever that may happen, ten grains more quinine must b i promptly administered, and the same course continued until an intermission of twenty-four hours has been established, after which the cinchona mixture must be continued every four, five, or six hours, with the addition of from two to six grains of quinine to each dose, according as the interval between them is longer or shorter, until convalescence is fairly established, when the periods for administering this medicine maybe reduced to three times a day, and gradually discontinued. The slightest over-feeding for many dm/s, may bring on a dangerous and sometimes fatal relapse. Complications may require separate treatment. In dysenteric diarrhcea, which is most common, I use large cold water injections containing a ^rachm (more or less according to the quantity injected) of muriated |inoture of iron. Cold water alone, carefully administered, and retained jby the pressure of the hand until tolerance is established, is of great ipervice. Should anodynes be required in order to quiet restlessness or promote sleep, I have found from ten to twenty grains of lupuline preferable tc pre- iJNtrations of opium. Whoever will give this treatment a fair trial in any of |he "Malarial" or so-called "Typhoid Fevers" occurring in these Territories #111 never afterwards be disposed to adopt any other. Typhoid symptoms [ways supervene if the fever is permitted to continue beyond the 14th or mosi the 21st day; but they are due to the progressive destruction of le red corpuscles of the blood by the microbe, and this will be arrested ly the destruction of the parasite, if the measures suggested are fairly iopted, Laveran having recently demonstrated b(• '->■ cinchona and its salts, more especially quinine, act when absorbed, in malarial disease, as direct ^ermie^es. I have not found the adminiiti'ation of alcoholic liquors (so largely resortf'd to by many), advisable during this fever; from what I have seen as the result of its two indiscriminate use by others, I believe .■ ' '^; f ■, .^. : 'r;<; •.tUp bgorbed; in (so largely have seen H greatly )ger to life. administri^ to hasten' C, . W. M. P. 1 )■, I : : ! s I .