the loss of blood. On this point there can be but little difference of opinion. Almost every author I have consulted, gives short directions for the removal of the cord from the neck of the child, and several of them recommend the cutting of it before the body shall be delivered, in order to protect its life.

Who would be willing to follow the recommendation of Blundell, and believe with him that "a better method" is to leave the cord around the neck until the body of the child is born, rather than remove it or cut it, when it was evident from the livid suffusion of the countenance of the half-born fœtus, that the circulation was impeded and death threatening? It is in such a case that procrastination would be attended with danger. It is here, that a "meddlesome midwifery," to employ in part the language of this fanciful writer, would be proper, rather than trust the case in the hands of that "excellent accoucheur in natural labourNature, the mother of us all."

The case I have presented is one of interest, and not only rare in its occurrence, but still more novel in its character; for as far as my researches have extended, I find no such instance on record. Baudelocque believes that it is possible for a cord, if short, to be ruptured before delivery; and Rigby says it has taken place, and he furnishes a reference in the London Med. and Surg. Journ. for May, 1835, p. 426, of a case which happened in the London General Hospital-but it was one of natural shortening of the cord-which was only two inches in length, and was ruptured before the child could be born. La Motte's cases and Burton's cases, as cited by Rigby, were artificial shortenings, but in neither of these did a rupture take place spontaneously before delivery. Burton ruptured both of his, and La Motte, who had three cases, cut one with his scissors, dragged another away with the placenta, and the third was delivered with little else than force.

Retention of Urine, a Sequela of Scarlatina, successfully treated with Strychnia. By Geo. L. UPSHUR, M. D.

W. H—————, a delicate child, æt. 7, of a nervous temperament and strumous diathesis, was attacked January 21st with ordinary symptoms of catarrh, accompanied by considerable febrile excitement, though he did not feel sufficiently indisposed to go to bed. On the 22d, he complained a little of sore throat; had not been exposed to scarlatina, but there was a case of well marked rubeola two doors off. Fever continued moderate until the night of the 24th, when it became higher, and the catarrhal symptoms were entirely superseded by the sore throat. I was called to

see him on the morning of the 25th, and found his condition as follows: Face flushed; throat red, swollen, and painful; headache; tongue furred white, with papillæ projecting; constant nausea and vomiting; and over the whole surface of the body there was an eruption partaking of the character of the rash of scarlatina and measles combined, but not sufficiently distinct to render the diagnosis certain; there was no cough or suffusion of the eyes. Prescription.-Warm mustard pediluvium. B. Pulv. Hyd. Chlor. Mit. gr. viii, Pulv. Ipecac. gr. iv, M. Pil. 4.-S., one every two hours. 26th. Rash abundant, and evidently that of scarlatina; fever moderate; thirst; great tenderness of the surface where the eruption is found; bowels were moved during the night; no nausea; thirst less painful. The patient continued in this condition without other treatment than a dose of Ol. Ricini, until the 29th, when the throat being more painful, I prescribed an emetic of Ipecac. and a gargle made of infusion of carrots.

From this time the patient commenced to convalesce, and I should not have bestowed further attention upon the case, but for the illness of another child in the same house. On the 9th of February, he complained to his mother of pain about the neck of the bladder, and inability to urinate. I was requested to see him in the afternoon of the 10th. Found him feverish, the bladder considerably distended, and suffering with headache. Had passed little or no urine since early in the morning. Ordered him to be put in a warm bath, and to take an ounce of caster oil and forty drops of laudanum immediately.

11th. Bladder very much distended; passed a restless night; bowels were moved twice, but no urine came away during the night; this morning there is styllicidium. Introduced the catheter, the operation being somewhat difficult from the smallness of the parts, and the existence of a partial congenital phymosis. There were three spasmodic strictures, situated about half an inch. apart, the first one being about an inch from the external orifice of the urethra. By keeping the point of the catheter steadily pressed upon the seats of stricture, in the course of ten minutes they gave way and the instrument entered the bladder. About eight ounces of urine were drawn off; when it ceased to flow, the catheter being clogged with mucous. After trying in vain to clear it with the wire staff, I was obliged to withdraw it, and he refused to permit me to introduce it again. The urine was turbid, and of the odour of asparagus.

12th. Passed no urine during the night, and has slept none; considerable fever and a haggard countenance. Ordered successively, a warm bath; tobacco leaf steeped in alcohol to the perineum; nauseating doses of tartar emetic: and last an opiate All of these means failing to relieve, resorted again to

enema.

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.

14th. 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: B. Strychniæ, 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 hours. 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.

18th. 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 sequela, 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 from 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 3j. 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 twice 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 sua 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 one. 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. By WM. ALEXANDER THOM, M. D., of Eastville, Northampton County, Virginia.

To the Editor of the Medical Examiner.

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 frequently 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 cause 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 the 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 administration 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.

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