357
In several of these severe cases retention has been met with, in this case it occurred on the 23rd June, (seventh day of illness) the question arises whether this is due to the fever or to the large doses of quinine given, as in these cases the retention is cured by small doses of strychnine, I am led to the conclusion that this is due to the direct effect of the malarial poison on the spinal cord.
Great care is taken to use a fresh solution of the neutral hydrobromate of quinine (1 in 6), and the syringe is provided with a platinum needle.
In this case there was slight stiffness of some of the muscles of the forearm, which disappeared in a short time evidently due to the direct irritation of the muscle fibres by the hypodermic solution.
The places selected for the injections are the calves of the legs, the shoulders (deltoid muscles) or the muscles of the forearm.
I attach to this a temperature chart of the case.
J. M. ATKINSON,
Appendix C.
CASES OF DYSENTERY TREATED WITH ARSENITE OF COPPER.
WM. L
ET. 58.
Admitted to the Hospital on December 1st, 1890, with a letter from Dr. BELL who informed me that this patient had been under his care since November 22nd, suffering from Acute Dysentery, as he had not improved under opium and large doses of ipecacuanha, he thought it better to send the man into the Hospital.
Patient stated that during the preceding twelve hours his bowels had been moved eight times. He said that he had been passing a quantity of blood and slime with his stools and there was considerable..... straining after a motion.
He was placed on milk diet, being allowed three pints of milk in the twenty-four hours, with two bottles of soda water and ice frequently, and was ordered one four hundredth of a grain of Arsenite of Copper every half hour in solution; at 9 P.M. that evening, his bowels had been moved six times, on examining his feces there was a quantity of mucus present but no blood.
December 2nd, on the morning visit, it was found that his bowels had been open four times during the night, fæces still liquid, no blood but mucus.
The medicine was ordered to be given every ten minutes for an hour, and after that in hourly doses (each dose containing one four hundredth of a grain). Evening visit, bowels had only been open once since the morning.
December 3rd, morning visit, bowels only open once during the night, less straining. Medicine ordered to be given every two hours, and some arrowroot was added to his diet. Evening visit, bowels not open at all during the day.
December 4th, morning visit, bowels had only been open once during the night, feces formed. December 5th, bowels open once during night, quite formed, he was now placed on low diet, and medicine ordered thrice daily. On the 7th, he was placed on half diet (fish), and on the 9th, was discharged cured.
PETER A
ÆT. 26.
Admitted to Hospital at 4.30 P.M. on November 8th, 1890, with history of diarrhoea for last four- teen days, motions have been as frequent as eight or nine times in the 24 hours, quite liquid mixed with mucus and occasionally blood stained, there has been distressing tenesmus.
His bowels had been moved six times that day, he was placed on milk diet and ordered 30 grains of pulv. ipecac. ver. preceded by an opiate draught given fifteen minutes before the powder.
November 9th, morning visit, bowels have been moved four times during the night, he vomited
balf an hour after having taken the powder.
Draught and powder repeated this morning.
Evening visit, bowels open thrice since morning.
10th, morning visit, bowels open four times during the night motions being distinctly dysenteric. One four hundredth of a grain of Arsenite of Copper was now given in solution and ordered to be repeated every two hours.
Evening visit, bowels only open twice since the morning. Arsenice of Copper mixture ordered to be continued.
November 11th, morning visit, bowels only open twice during the night, fœces slightly formed, very little straining.
Evening visit, bowels open twice during the day, patient expresses himself as feeling much better. November 12th, morning visit, bowels only open once during the night, mixtured ordered every four hours.
From this date he made a complete recovery, on the 14th, he was placed on low diet, and on the 19th on half diet, and was discharged cured on the 20th instant.