THE MEDICAL EXAMINER AND RECORD OF MEDICAL SCIENCE. NEW SERIES.-No. XXVII.-MARCH, 1847. ORIGINAL COMMUNICATIONS. Statistics of Cases of Miasmatic Fever treated in 1846. By GEORGE L. UPSHUR, M. D., of Norfolk, Virginia. During the past year, 105 cases of miasmatic fever came under my care. Of these, 83 were Intermittent, and 22 Remittent. Of the intermittent, 1 was quartan, 15 tertian, 62 quotidian, and 5 masked. Of the masked, one took the form of neuralgia, and four simulated hysteria. The treatment chiefly employed was the sulphate of quinine, administered in large doses, without regard to the stage of the disease. In one case-a quotidian-occurring in a youth aged 16, of sanguineous, excitable temperament, I adminisiered 15 grains just as the cold stage was passing off. All the symptoms were ameliorated; the hot stage lasted but one hour, and the patient had no return of the disease. In 25 cases, I gave 30 grains in five hours, during the height of the febrile stage. The pulse was lessened in force and frequency in every instance under this treatment, and the paroxysm cut short by the speedy appearance of perspiration. In only one of these cases was the remedy preceded by other treatment. The exception was the case of an exceedingly robust man, in whom there existed, even in his ordinary health, a strong tendency of blood to the head. I bled him to twenty ounces before administering the quinine. He returned to his work (that of a baker,) forty-eight hours afterwards, and had no return of the fever during the season. He told me that for several years past he had not escaped an attack of bilious fever in the autumn, and that he was usually kept in his bed by it for three weks. Said that he had taken the quinine before, but not while the "fever was on." In one case, the patient was partially comatose during the first paroxysm. This condition was relieved, in a measure, by a cathartic of calomel and aloes. Three hours before the second chill was expected, I administered 25 grains of quinine, and followed this by 15 grains more two hours afterwards. The patient missed the paroxysm and went to work the next day. In 14 cases there was a recurrence of the disease. The recurrence in ten of these, however, could be positively traced to a second exposure to the causes of the affection. The masked forms of the disease yielded readily to the quinine treatment. One of the cases which simulated hysteria was remarkably severe in its character, the patient being seized every afternoon with violent convulsions, accompanied by flushed face and considerable excitement of the circulation. She was treated at first by active purgation, and vesicants to the nucha, with only slight abatement in the intensity of the paroxysm. The regularity with which the attacks came, coupled with the fact that the patient resided in a part of the city where intermittent fever was prevailing, suggested the employment of quinine. She commenced early in the morning with five grains every hour, and took thirty grains. The paroxysm was much milder in the evening, and did not recur at all on the next day. She remained well for seven days, when she was again attacked as in the first instance, and again relieved by the same treatment. She subsequently had a third attack which was cured in the same manner. Her catamenia had been interrupted for six months previous to her sickness, and did not return until six weeks after the last attack. I was not called to a single case of remittent fever at the beginning of the disease. In one case the patient had been ill eleven days without any treatment whatever; she was much emaciated, and had suffered from diarrhoea for six days. I gave her a table spoonful of the following mixture every hour: B. Quiniæ Sulph. M. Morph. Sulph. 3ss. f. ziij. In the course of five or six hours she perspired freely, fell into a quiet sleep, and in two days after was entirely free from disease. This was the sole treatment of the case, except the tinct. chlorid. ferri, which was given for ten days after convalescence was established. 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 nauseated 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 diarrhoea, 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 put 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 diarrhoea and irritable stomach. I also gave in many cases where the skin was very dry and the thirst urgent, 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., Frankford, 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 medical 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 small 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, anxious 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 attention. 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 SWIFT, 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 |