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was 24th of April last, until a few days since, when I visited her, in order to report upon
condition. She has been doing the labour of a hand upon the farm, for some two months now. The remains of the mamma are about half the size of the well-formed natural one-the skin is regularly contracted and adherent—the ulcers are all healed soundly, except a very smal! per. foration, still giving exit to some discharge, of inoffensive appearance. Her general health is perfect in all respects, having recovered her former flesh, activity and cheerfulness of mind.-Southern Med. and Surg. Journal.
Remarks on the use of the terms “ Congestion” and “ Congestive." By Thomas C. Brown, M. D., of Woodville, Miss.—The term Congestive Fever has become so familiar in the South and West, that the young and inexperienced are led to look for a distinctly marked and peculiar fever, and are sadly perplexed in their investigations. At one time it is described as "algid intermittent fever," at another as “malignant or pernicious remittent fever.” They find it supervening on intermittent, remittent and continued fevers—on gastritis and gastro-enteritis-on typhoid pneumonia—on epidemic dysentery; and in fact, as complicated with most of our summer and autumnal diseases, and sometimes with our winter epidemics.
Would it not be well for the medical profession, if our journalists and teachers of medicine, would teach that "there is not, properly, any fever characterized by congestion in contrast with another which is without it;" but that congestion is common to nearly all fevers, whether intermittent, remitient, or continued; and that it is not limited to any one organ: the brain, the spinal column, the lungs, the liver, the spleen, the kidnies and abdominal viscera, may be the seats of congestion, either separately or several of them at the same time; and these as they are separately or severally affected, will cha. racterize the symptoms according to the organ or the several organs which may be involved ?
The term Congestion comes from the Latin congero, lo amass, and in a medical sense conveys the idea of turgescence or fulness of blood in a particular part, and implies simple engorgement and over distension o? the bluod vessels. It seeins rather the result of irritation than of inflammatory action, and when it passes into inflammation, it would seem to be more dependent on the general state of the constitution, on the plethoric condition of the blood vessels, with the ten. dency towards inflammatory excitement, than on the primary irritation which occasioned it. The presence of internal congestions must, of course, be inferred from the symptoms which indicate them, and to connect the symptoms with the structural lesions which they denote, so as to furnish practical guidance in the treatment of them, is the proper object of medical research.
Their treatment must depend in part on the nature of their site, but principally on the cause which occasions them. If congestion result from a plethoric habit, mere local treatment can never give permanent and effectual relief; on the contrary, if the congestion be owing to irritation only, then general depletion is unnecessary, and would be injurious.
Congestion generally precedes, but may follow inflammation, by the irritation set up in neighbouring organs, or be transmitted to those more distant by nervous influence. Strong innervation, in which the nervous centres are much excited as under various emotions, will produce congestion, at one time of the brain, at another of the lungs or liver. Certain nervous affections, as hysteria, will give rise to irregular determination and retardation of blood, producing congestion in some organ, which often entirely disappears after the removal of the nervous disturbance. Congestion dependent on mere nervous disorder, will generally be irregular or periodical in its appearance, but if there be a permanent disorder of function in an organ, the congestion depends upon permanent irritation. In the commencement of fevers the congestion is of an irregular or periodic character, but when occurring in the latter stages of fever, it is usually of a more permanent and dangerous character.
Congestion, coming on in the progress of intermittent and remittent fevers, is of frequent occurrence, and when supervening in the latter stages of these diseases, it generally indicates great danger; but when it ushers in an intermittent fever, and the paroxysm is followed by verv feeble reaction, it indicates great danger.
The symptoms of the congestion of a particular organ, or of several organs, combining with the sympathy of a particular fever or disease, upon which it supervenes, must, necessarily, give rise to great diver. sity of symptoms, and will require a variety of treatment as dictated by the existing circumstances. Hence the confusion which results in an attempt to study the symptoms of congestive fever, as a distinct species of fever. If we are to have a nosology, in which congestion is to be the cognomen of a particular species, we must adopt a division of fever somewhat like the arrangement of Armstrong, and dispense with the distinctions of fever into intermittent, remittent and continued.-New Orleans Med. and Surg. Journ.
Blindness Caused by the Use of Sulph. Quinine. By John McLEAN, M. D., Prof. of Materia Medica in the Rush Medical College. -Quinine when freely administered produces a species of intoxication, tinnitus aurium, a sense of fulness in the head, cephalagia, and other affections; and sometimes, although not so frequently, blindness, more or less lasting.
M. Trousseau, relates the case of a tailor, who, for the relief of a periodical asthma, took 48 grs. of the sulph. quinine, at one dose. In four hours he experienced ringing in the ears. dulness of the senses and vertigo ; and in seven hours. he was blind and deaf, his mind wandered and he was unable to walk. These effects, for which no active medicine was administered, gave way spontaneously, during the night. A young girl at the “Hospital Cochin," in consequence of having taken freely of the sulph. quinine, became affected with amaurosis, which continued at the end of three weeks, notwithstanding appropriate and energetic means were employed for the restoration of her sight.
Dr. Rognetla, who claims for Rasori, priority in the use of quinine in acute rheumatism, “thinks, with the Italian physicians that the limits of tolerance should not be exceeded, and that beyond this, a species of poisoning may be induced, known by deafness, blindness, hallucinations, hæmaturia, &.'"
Blindness, although not so common as the other effects, is not un. frequently produced, and may be prolonged for months or even years. It is not, however, generally known, that such may be the result of this inedicine, when given in large quantities. The following are some cases occurring in this place and immediate vicinity, which show that when thus administered it inay produce blindness more or less permanent.
Case 1st. Mr. P, of the town of Barry, Jackson co., was in the year 1840 attacked with a low grade of reinittent lever, the nature of which was such, as to cause the attending physician to administer the sulph. quinine in large and frequent doses. Sixteen grains, (as judged by sight,) were ordered every hour, and continued until nearly one ounce was taken. Before the quinine was discontinued, he became perfectly blind, which, with a slow and gradual amendment, continued during the first year. Later than this, I have not been positively informed in regard to the case, but should judge, from what indirect information I have received, that his sight is not yet perfectly restored.
Case 2d. Mrs. B., of the town of Concord in this county, was, a few years since, reduced so low by the endemic fever of the country, that her life was despaired of. As a last resort large quantities of quinine were given, and while taking it she became blind, which continued for several weeks. As she recovered her health the blindness gave way, and her sight was finally restored. Not being acquainted with the particulars of this case, I can give but these few general outlines.
Case 3d. P. M. Everett, of this place, was, in the autumn of 1843, attacked with remitlent fever, and in a few days became so greatly reduced, as to leave but slight hopes of his recovery. Sulph. Quinine was therefore prescribed, in doses averaging three grains, every hour, and was continued for three days. In a short time, he became deaf, and soon after so blind that he could not see a burning candle, when placed immediately before his eyes. The blindness took place on the third day, after the commencement of the free administration of the sulph. quinine. Previous to this, and at this time, bis mind, (with the exception of occasional slight wanderings) appeared to be perfectly clear. After soine weeks, his sight becaine partially restored, but continues more or less imperfect, even at the present time.
During the greater part of the first year, he could look steadily at
the sun, without seeing it, or even any painful sensation being produced. When he first began to see sufficiently to read, which was in the course of the first year, he could perceive but a small luminous spot upon the paper, about one inch in diameter, within which he could distinguish letters, but all wiihout this was cloudless and confusion. During this time, the pupils were very much dilated, and he could see objects at a distance much better than those near by. His sight has continued to improve, ever since ; and at the present time, although quite imperfect, is sufficiently good to enable him to read and write, although with some difficulty. The pripils are still considerably dilated, and it is with great difficulty, that he can discern objects by twilight. The direct rays of the sun upon the head, produce pain there, accompanied with a painful sensation deep in the orbit of the eye, and a disordered vision. At the present time, exercise easily produces fatigue, by which his sight is much im. paired.
Case 4th. In the month of April, 1846, Dr. R. of this place took in doses of six grs. each, three drachms of quinine in 36 hours ; at the expiration of which time, he became perfectly blind. His hear. ing was somewhat blunted, although it did not, in degree, equal the blindness. On the two succeeding days, his sight, although very imperfect was considerably restored. Had he lived, the probabiliiy is, that this imperfect sight would, as in the former cases, have continued a considerable length of time.
Remarks.—We think it clear that the blindness in the foregoing cases was the effect of the quinine ; for we see it in each, coming on suddenly during its adıninistration in large quantities, and at a time, when no other medicine was given that would be likely to produce such results. Here, cause and effect appear to be closely connected, and are so plain, as scarcely to admit of the possibility of a doubt. From the symptoms accompanying the foregoing cases, we judge that the proximate cause of the blindness, was mainly an affection of the retina or optic nerve, producing amaurosis.
I have recorded the foregoing facts, with the hope that they might be the means of causing some useful suggestions, in relation to the physiological effect and administration of this medicine.
In connection with the foregoing, we might mention the case of Mr. B. Porter, of this town, who has had for sixteen years and upwards, amaurosis of the left eye, which he supposed to have been produced by the application of a strong subacetate of copper ointment to that side of the face, for the purpose of curing Herpes circinatus. As the ringworm gave way, the blindness came on.
About one year since, he suffered with a periodical neuralgia, for which I ordered 32 grs. of quinine to be taken in divided doses of 4 grs. each, every two hours. Under its influence, the neuralgia disappeared ; and on the following day, he could see objects quite distinctly with the amaurotic eye, much better than ever before, since it first became diseased, and he was much elated with the thought
of soon regaining its sight. He, however, look no more quinine, and in a few days, the benefit produced to that eye was entirely lost. Jackson, (Mich.) Sept. 22, 1846.
Illinois and Indiana Med. and Surg. Jour.
On the Effects of Mercury on the Young Subject.-By John B. Beck, M. D., Professor of Materia Medica and Medical Jurisprudence, in the College of Physicians and Surgeons, of New York. In some previous papers, I endeavoured to point out the peculiarities attending the operation of Opium and Emetics, on the infant subject, as distinguished from the effects of these agents on the adult. I now propose to make some remarks on another article of even still greater importance, and that is Mercury. That Mercury is an agent of immense power, either for good or evil
, upon the human constitution, cannot be questioned. While in many cases it is the means of saving life, in not a few it unquestionably destroys it. If this be so, it becomes a question of the deepest practical interest, to determine whether its action is modified in any way by the age of the patient, and particularly so, when it is recollected that it is given by too many physicians, even more freely, and may I not add indiscriminately, to the young subject than to the adult.
The first and most striking peculiarily attending the action of mercury is, that in young subjects, it does not produce salivation so readi. ly as it does in adults. Indeed, under a certain age, it appears to be exceedingly difficult to excite salivation at all in them. On this point, besides our own experience, we have abundance of testimony. Dr. Clarke says, “under various circumstances he has prescribed mercury, in very large quantities, and in a great number of cases ; and he never produced salivation, except in three instances, in any child under ihree years of age." Dr. Warren, of Boston, observes, that he has never known an infant to be salivated, notwithstanding he has given in some cases, large quantities with this view.” Mr. Colles, of Dublin, says, “no man in the present day requires to be told that mercury never does produce ptyalism, or swelling and ulceration of the gums in infants." Drs. Evanson and Maunsell speak still more strongly. They say, "mercury does not seem capable of salivating an infant. We have never seen it do so, nor are we aware of any such case being on record.” “We have never succeeded in salivating a child under three years of age.”
The same general fact seeins to be applicable to the external use of mercury. Dr. Percival, of Manchester, remarks, that he “repeatedly observed that very large quantities of the Unguentum Cæruleum may be used in infancy and childhood, without affecting the gums, notwithstanding the predisposition to a flux of saliva, at a period of life incident to dentition.”
That salivation does not take place so readily in the infant as in the adult, would seem then to be well established. That it never can or does take place, as might be inferred from some of the preceding quotations, is by no means, however, true; and the statement,