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the catheter, being obliged to have the patient forcibly held. Drew off about a quart of urine with entire relief.
13th. Symptoms as yesterday. Ordered a cathartic and large doses of the Tr. Ferri Chlor. Passed no urine during the day, and in the evening introduced the catheter.
141h. Could not get the catheter more than two inches in the urethra, the stricture refusing to yield though pressed upon for twenty minutes. Ordered forty drops of laudanum, and repeat it if necessary
15th. Bladder much distended, although the urine has been dribbling away all night. Again tried the catheter. After holding it against the stricture a few minutes, the spasm suddenly gave way, and a stream of urine forcibly ejected the instrument from the urethra; he passed about half a pint, when it suddenly stopped, causing great pain. Ordered the following:
R. Strychuiæ, gr. ss.
Pulv. Rhei, gr. xx.
M. Pil. 8.-S. One every five hours. 16th. Has taken four pills, and passed during the night about half a pint of urine. Complains of pain in the epigastrium; there is some twitching of the extremities. Continue the pills every four hors. In the evening he was free from fever and had urinated tolerably freely during the day.
17th. Passes his urine better, but there is still some pain and spasm about the neck of the bladder. Continue treatment. Evening. Twitching better marked and very general; observed it even in the occipito-frontalis muscle. Urinates with little or no difficulty. Discontinue medicine.
181h. Bowels moved during the night, and urine voided as in health. From this time he convalesced rapidly, and is now (March 5th) perfectly well.
Remarks. No writer upon scarlatina speaks of retention of urine as one of its sequelæ, and I am disposed to look upon its occurrence in this instance as a coincidence instead of a sequence. The child was of a nervous, irritable temperament, and in all probability any febrile action continued for several days would have been followed by the same effect. Be this as it may, however, retention of urine, under any circumstances, may justly be considered a distressing and serious complaint, for the relief of which a variety of remedies have, from time to time, been suggested.
Mr. Holbrook (Med. Chir. Rev., March, 1824) recommends the use of active cathartics, and reports several cases of cure frorn their employment. This treatment is based upon the wellknown fact that the rectum is seldom or never evacuated without a simultaneous emptying of the bladder.
M. Gerard (Jour. des Connais. Med. Chir., May, 1835) successfully treated four cases of retention of urine by frictions with ointment of belladonna over the hypogastrium. Before resorting to this treatment, the warm bath, opiates, venesection, leeches and anodyne enemata were tried without success. The ointment was made by rubbing up 3ij. of the Ext. Belladon. with zj. of lard.
Dr. Somervail (Am. Jour. Med. Sci., Vol. xvi, p. 250) relates a case cured by muriate of ammonia, in doses of five grains every hour. He thinks the retention was caused by a large dose of solution of morphia, which the patient had taken for the relief of violent pain.
The only case I can find recorded in which strychnia has been employed for retention of urine, is given by Dr. Cory (Med. Chir. Rev., July, 1839.) The patient was left, after labour with her first child, with total loss of power on the part of the bladder. It was necessary, for her relief, to use the catheter iwice a day for three weeks. She was ordered to take one-sixteenth of a grain of strychnia three times a day. “I was, I must confess," says the author," “ somewhat surprised to find my patient, after taking the second dose, pass her urine suá sponte, and with ease and comfort to herself." The medicine was continued until about a grain had been taken, when the cure was complete. The author does not mention the use of any other means except the catheter.
Ergot, muriated tincture of iron and cantharides, have been highly extolled in the treatment of retention of urine. I have never given any of these except the Tr. Chlor. Fer., which failed in the case above reported, although the trial was a fair
I should be more disposed to rely, in future, upon the belladonna ointment or the strychnia. The efficacy of these remedies, however, depends, of course, upon the cause of the affection. In retention of urine, so often found in old men, and which is dependent upon enlargement of the prostate gland, I presume they would not benefit at all. But where the retention is dependent upon spasmodic stricture of the urethra, or paralysis of the fundus of the bladder, or upon both these conditions, I feel persuaded that but a very small proportion of such cases would refuse to yield to this treatment.
Norfolk, (Va.,) March 5th, 1847.
On the Effects of large doses of the Sulphate of Quinine. Ву
WM. ALEXANDER Thom, M. D., of Eastville, Northampton
In these days of ultraism and exclusiveness in medical matters, I have thought it might not be amiss to report the following cases, illustrative of some of the effects of very large and fre. quently repeated doses of quinine. I regret that the imperfect notes of the cases preserved, will permit my giving little more than an outline of the symptoms and treatment; enough, however, remains to show that the quinine was the direct calise of the unpleasant symptoms occurring at the conclusion of the treatment; and although all the cases ultimately did well, they still warn us of the dangers attending the indiscriminate administration of this most valuable, but much abused agent. All the cases occurred in the course of the past fall, and three out of four in children of from six to eight years of age, and all were ill with some modification of miasmatic fever, assuming the ordinary remittent or congestive form distinguishing our autumnal diseases. The fourth case will be found to furnish another instance of amaurosis produced by quinine, and affords additional evidence of the correctness of Dr. McLean's opinion on this subject, as expressed in an article transferred to the “Record” of ihe Examiner for February of this year. This was the first case of the kind which had ever come under my observation, in which the effect so immediately followed the adıninistration of the remedy ; and I was somewhat at a loss whether to ascribe it to this or not. Dr. McLean's paper, however, has satisfied me on this point.
The phenomena presented by all the cases are explicable only on the idea that quinine exerts a powerfully sedative action on the nervous system. The symptoms manifested,—though in a less degree, were not unlike those exhibited by some constitutions under the peculiar action of mercury, and described by Mr. Pearson as mercurial erethism. Smaller doses of the medicine had, in all the cases, been tried in vain, and I am satisfied that nothing but very large and frequently repeated doses, could have saved the lives of two of them. It will be seen, however, that in most of the cases the quantity of quinine taken was not inordinately great.
Case 1. A little girl, æt. 7, with remittent of the ordinary form, exacerbation occurring daily about noon. When I saw her, the remission had just begun; I ordered two grains of quinine in solution every hour until she had taken twelve grains ; afterwards a cathartic of sulphate of potassa and rhubarb. The next day her fever recurred at the usual time as high as ever. Prescription.-R. Hydrarg. chlor. mit. gr. vj., pulv. ipecac. gr.iij. M. Div. in chart. 6.-S. One every two hours; and afterwards, as the paroxysm was expected in four hours, to take five grains of quinine, and repeat it in an hour. She took ten grains; fever rose as usual. At the next remission I ordered her to have sixteen grains of quinine at two doses, with an interval of two hours. When the next paroxysm was expected, I found my patient free from fever, but with a quick, rather weak and thready pulse, mind slow, tongue tremulous, skin cool and moist, All these symptoms subsided entirely in less than twenty-four hours, and she has never had a fever since.
Case 2. Negro boy, æt. 6 or 7, ill with severe remittent fever with powerful determination to the brain, accompanied by a high grade of arterial excitement. I bled him, and ordered a solution of nitrate of potassa and tartar emetic, as he had been purged previously to my seeing him. An indistinct remission occurred for a short time every morning; as soon as this came on, ordered three grains of quinine every hour. He took only six grains when an exacerbation of fever took place, with congestion of liver and stomach. Prescription.-R. Hydrarg. chlor. mit. gr. viii., pulv. ipecac. gr. iv. M. Div. in chart. 4.-S., one every two hours. He took all the powders, which acted gently on the bowels and produced a more perfect remission. Ordered five grains each of quinine and rhubarb, and repeat it in an hour. Soon after the last dose was exhibited, reaction again came on violently, attended with great heat of the skin, thirst, dry tongue, and pulse somewhat tense and irritable, but with little force or fulness. By the use of febrifuge medicines this condition yielded to a partial remission, and I ordered eight grains of quinine, to be repeated in an hour. At my next visit I found my patient without fever, with a cool and moist skin, small, quick and thready pulse, tremulouis tongue, and rather torpid intellect. These symptoms soon subsided, and he had a rapid convalescence.
Case 3. Attended Mrs. M. æt. about 35, in consultation with the late Dr. John Ker; had been sick about ten days with an obstinate, but not very violent attack of remittent fever ; she had previously taken quinine in small doses, been purged, blistered, iaken mercury, fc. We ordered quinine in ten grain doses, at intervals of two hours; she took twenty grains when her fever rose, having previously to this complained of noises in her ears &c., from the use of the medicine. During the next remission she took thirty grains of quinine in three doses. That night we
. found our patient exhibiting such symptoms of prostration as obliged us to use strong stimulants for her relief. Her pulse was small, thready and weak, skin cool and clammy, much nausea, and mind torpid. After these were relieved, she began to recover slowly, though for some days she had occasional returns of fever.
Case 4. Attended George, about 8 years old, in consultation with Dr. Bagwell of this county. The case was a very severe remittent fever, accompanied by violent congestion of the stomach. He had been previously purged, blistered, &c., and as soon as a partial remission occurred we recommenced giving quinine in five grain doses, repeated every two hours. This was continued during two remissions without any appreciable effect, when Dr. B., who remained with the patient, increased the dose and shortened the interval. The quantity taken in three days is not accurately known, but I should think was not much less than two scruples. As soon as the constitutional effects of the medicine were induced, the disease yielded; but dilatation of the pupil, insensibility to light, and almost total loss of vision followed. The amaurotic condition slowly improved without remedies, and he is now perfectly restored.
I am informed by a physician of this place, that a case similar to some of the above occurred in his family in the course of last fall. A young lady was so prostrated by taking about 20 grains of quinine in two doses, as to require artificial heat to the surface and strong stimulants to restore her. The symptoms were similar to those of the three first cases recorded above.
Eastville, Northampton, Co. (Va.) Feb. 1847.
To the Editor of the Medical Examiner.
I have recently observed the evolution of electricity, under circumstances with which I do not know that it has been heretofore noticed.
Standing before a brisk coal fire, and under a large glass chandelier furnished with gas, I was, with other persons in the room,
I making remarks upon the latter. In the course of these, I touched a tube leading to one of the burners, when there ensued a spark andible to all in the room, and distinctly felt by myself. This was repeated several times by myself as well as the other persons, and many sparks were elicited.
At first I thought that there might be some connexion between the electricity and the combustion of gas, but a moment's reflection convinced me, that the metallic connexion of the burner with the ground rendered this impossible.
It has since occurred to me, that the electricity was generated upon my own person by the friction of my clothes, and that being insulated by the carpet upon which I was standing, I was VOL. X.