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The other cases were managed after the same manner—the large doses of quinine being preceded by a simple cathartic of jalap and bitartrate of potassa, in those cases only where there was great torpor of the bowels.
Not one of the 105 cases died, and all together did not take a drachm of calomel, or other preparation of mercury.
I observed unpleasant symptoms in only three cases, where they seemed to be at all dependent upon the large doses of quinine.
1. A delicate, nervous female, aged 36, was ordered 5 grains every hour, for a second attack of quotidian intermittent. When she had taken 20 grains, she became suddenly pauseated and vomited up three mouthfuls of scarlet blood. This occurred in the morning, and the chill was expected late in the afternoon. The medicine was suspended immediately, and she missed the paroxysm, and recovered without any other untoward symptom. She was treated with quinine for the first attack and also for a third, without any such effect being produced. The hæmatemesis was not vicarious of the menstrual discharge, as the catamenia had not been interrupted.
2. In this case the quinine vomited the patient like full doses of tartar emetic. She took twenty grains in five grain doses in solution, combined with spt. æth. nit. There was no gastric derangement prior to the exhibition of the medicine.
3. In the third case the patient, a female aged 40, who had but recently recovered from a very severe attack of lichen agrius, was rendered deaf, or nearly so, for ten days, by taking forty grains of quinine in eight hours. The intermittent, a tertian, was permanently cured.
I was never deterred from giving the quinine by the existence of diarrhea, irritability of the stomach, or headache, provided the case was urgent, and it was absolutely necessary to put an immediate stop to the paroxysms. In cases of great torpor of the bowels, if there was time to spare, I preferred to begin the treatment by purging freely, because the quinine is not readily absorbed if there is much constipation. Usually however the safer practice is to piit an end to the paroxysms first, and afterwards attend to the local affections.
I have found great benefit from combining the sulphate of morphia with quinine, especially in those cases complicated with diarrhea and irritable stomach. I also gave in many cases where the skin was very dry and the thirst irgent, the spt. æth. nit. combined with a solution of quinine, with great benefit.
My experience in the treatment of miasmatic fever in 1846, leads me to the following conclusions :
1. In a large majority of cases, no matter of what type the fever is, the "preparatory treatment," so called, is worse than useless, causing a loss of time which is often fatal to the patient.
2. A large dose of quinine, (15 or 20 grains,) administered at once, produces a more certain and permanent curative impression upon the system, than small doses (1 or 2 grains) frequently repeated.
Quinine in large doses, when administered in the hot stage, so far from exciting the circulation, acts as a decided sedative upon it-the pulse in every instance lessening in force and frequency under its influence. The dogma, therefore, that “quinine in fever is poison,” must be discarded.
4. In uncomplicated miasmatic fever, mercurials are not at all essential to a complete and permanent cure. They may sometimes be given with advantage in cases where cathartics are indicated at the onset of the disease.
Norfolk, Va., February 6th, 1847.
On Polypus of the Rectum. By Robert Burns, M. D., Frank
ford, Pennsylvania. To the Editor of the Medical Examiner.
Sir,-On perusing the January number of the Examiner, my attention was drawn particularly to an article among your medi. cal records, upon Polypus of the Rectum, which recalled to my remembrance a case of this kind, which came under my care in the early part of the past summer; and should the following notice of the same be thought worth an insertion in your journal, it is at your disposal.
E. K. Y-S was from her birth what her mother termed a very troublesome child, being frequently indisposed. When about two and a half or three years old, her mother observed that she suffered much distress previous to the act of defecation, and before it could be accomplished, there was a protrusion of a dark red fleshy substance ex ano, which bled less or more on every occasion of the kind. This tumour was shortly associated with a second of smaller size, which, after remaining some months, separated from the larger one ; this latter continued to enlarge, until, according to the mother's description, it had acquired the size of a sinall hen's egg. She states it was exceedingly troublesome, requiring to be replaced within the sphincter ani after every evacuation. This prolapse of the polypus always took place before the evacuation of the intestine, and never went up without manual assistance. This state of things continued up to the age of five years, when I was consulted upon the case. At this time the child was considerably reduced by sanguineous discharge. She had a distressed, anxions appearance, with great timidity resulting from the knowledge of her infirmity, and apparent consciousness that others knew it also. This rendered her an object of deep consideration and sympathy, apart from the usual and necessary interest which must be felt in every case of suffering humanity by the medical practitioner. The physical development of this child was naturally good, her eyes and skin dark, hair brown, and countenance open and intelligent.
On examination of the anus, I found a polypus protruding as large as a small seckel pear, being considerably diminished at the time from frequent bleedings. On dilating the anus as much as possible, by traction in opposite directions, I found the pedicle to be somewhat elongated from the mucous membrane of the rectum above the sphincter; to this I immediately applied a ligature of silk thread, allowing the ends to remain long, which were secured externally by a strip of adhesive plaster; about twenty-four hours after its application the polypus separated, and two days after, the ligature came away. She suffered some pain while the ligature remained, which did not demand special atten
Since its removal, about eight months have passed away, and there has been no return of the disease; no hemorrhage, the function of the part is normal, and the child's health and appearance very much improved.
On Wounds from Fire-Arms without Ball. By Paul Swirt,
M. D., Philadelphia. There is obviously a wide spread popular error in relation to the effect of the explosion of gunpowder without ball; and even professional writers on this subject are not very definite in regard to the distance at which a pistol, or other fire-arm, so loaded, may be discharged without inflicting a dangerous wound.
The popular notion and language is, that the piece is not loaded unless it be charged with ball, slug, or shot, as well as powder, and that its discharge is quite safe even when held near the person. Moreover, when wounds do occur from such discharges, all parties seem quite sure that the wad is the immediate cause. The following case will illustrate the prevalence of this opinion and its fallacy.
On last New Year's eve, at the Good Will Engine house, Wm. Simler, a minor, playfully, but heedlessly, fired a pistol charged with powder only, at his friend and companion Robert W. Pitt, inflicting a serious wound. Pitt, staggering into the
arms of his friends, cried out, “ I am shot." Simler, thinking him frightened, but not harmed, said, laughing, "It was not loaded," or, as another witness testified, “It had no ball in it.' The wound was on the fleshy part of the left hip, above and behind the trochanter major, about one inch in diameter, and four inches in depth; the integuments were destroyed, and the muscles presented a blackened, mangled mass: it bled but little, and was carefully probed with the finger which readily passed to the bottom of the wound. No uutoward symptom arose till the sixth day, when tetanus in its most distressing form, opisthotonos, supervened, and he died on the morning of the seventh.
On a careful post-mortem examination, no foreign substance was found but a minute fragment of woollen cloth, about two inches from the surface, and grains of gunpowder, with which the wound, through its whole extent, wus blackened.
Thus it was evident that this fatal wound was caused by the explosion of gunpowder in a pistol of ordinary size; a wound at least four times as large as a ball froni the same instrument would have caused; and so mangled were the tissues, through this great extent, that vitality was utterly destroyed. Had the unfortunate young man lived, it must have been through great suffering, necessarily attending the tedious and exhausting sloughing of the dead mass.
Al the legal investigation which followed, there was some discrepancy in the testimony in regard to the distance at which the pistol was held when the wound was inflicted, the witnesses differing from one foot to two or three yards; nor is this very strange, as it occurred in the night, in a place not well lighted, and in the midst of a moving throng of some twenty individuals. The patient himself, however, declared his belief that the weapon “almost touched him.” The pistol was said, by Simler, to have had a paper wad; but no wad was at any time found, and the evidence given at the time rendered it quite probable none was used.
Being one of the professional attendants in this case, I was somewhat surprised at the character and extent of the wound; it was obvious no ball could have produced it; nor was it conceiva. ble that a paper wad could have caused snch extensive lesions. A considerable research in works on medical jurisprudence failed to give satisfaction, and though the circumstances forced upon my mind the inference that a heavy charge of powder, exploded near the part, had alone caused the mischief, yet, as young Simler had been bound over for trial before a criminal court, it seemed very desirable to possess farther data in the premises. With this view I sought, and, through the courtesy of the officers of Jefferson Medical College, obtained the facilities for making the following experiments, which were used at the subsequent trial, and are now offered to the public with a hope that they may be useful in future medico-legal investigations of this nature. The pistol-the same used by Simler—was wadded with paper, and has a bore about four inches in depth and six lines caliber.
Experiment ist.–Pistol with an ordinary charge was held 12 inches from Aeshy part of hip, the part being covered with one thickness of broadcloth and a twilled cotion cloth under itClothes lacerated, and skin abraded ; wad on the flour, on fire.
Experiment 2d.—Distance 6 inches; parts covered as before, clothes lacerated; wad lodged one inch and a half below the surface.
Experiment 3d.--Distance 2 inches-wound ragged, blackened with powder, and penetrating to the bone-one and a half to two inches-wad was found immediately beneath the integuments, and somewhat on one side of the principal woundparts covered as before.
Experiment tth.-Distance one and a half inch from the ribs of the right side-10 covering of cloth-penetrated the cavity of the chest, the wad passing through the intercostals between the ribs.
Experiment 5th.—Distance the same-uo corering of cloth, the integuments removed-wad penetrated the thorax, carrying away a transverse portion of the rib.
The subject, about 35 years of age, a male, not recent, had undergone a preserving process with chloride of mercury, considerably hardening the muscles ; it was also much emaciated.
SYDENHAM Society's WORKS:- The works of William Hewson,
F. R. S., edited with an Introduction und Notes, by GEORGE GULLIVER, F. R. S., Surgeon in the Royal Regiment of Horse Guards. 8vo. pp. 360. London, 1846.
The works of Hewson, which form the first volume isstied hy the Sydenham Society for the year 1846, ought to be especially interesting to the American reader. Hewson himself died at the early age of 34, and his widow with her two sons and daughter,