347

good health till two months ago, when she was seized withpain in her limbs, succeeded by cold shivering, and other painssymptomatic of ague, continuing up to the present time. Shecommenced menstruating at the age of sixteen, and has beenregular since. On admission, the patient was pale and anaemic-looking, having eruptions of secondary syphilis upon her legs,arms, and body. She positively denies that any primarysymptoms ever existed. She has, however, been undermedical treatment for the eruptions, independent of the ague,for the last two months; but she experienced very littlerelief from treatment, and, as a last resource, determined tocome into the hospital. The spleen was found to be verymuch enlarged. Ordered, three grains of quinine every threehours.

Feb. 22nd.-No return of the ague; appetite not very good;bowels regular; complains much of thirst.24th.-Had a return of the ague-fit to-day.26th.-The quinine mixture to be taken twice a day, and

five grains of Plummer’s pill night and morning.March 2nd.-Much better; eruption gradually disappear-

ing.20th.-No return of the ague; the spots are almost entirely

gone.24th. -Discharged cured; the spleen normal in size.

ST. MARY’S HOSPITAL.

TERTIAN AGUE OF SHORT DURATION, WITH AN ENLARGEDAND TENDER SPLEEN ; COMPLETE CURE.

(Under the care of Dr. CHAMBERS.)EQUALLY with the preceding case, the present was a mild

example of ague, of but a month’s duration before admission, ina patient who had been in Kent, and very likely exposed tomalarious influences whilst following her avocation as a hop-picker. The spleen, notwithstanding the short period of ill-ness, became enlarged and very tender, but recovered its nor-mal condition after a few days’ treatment with quinine. We areindebted to Dr. Broadbent, house-physician to the hospital, forthe notes of the case :-Rebecca S-, aged twenty, single, hop-picker, admitted

October 10th, 1859, under the care of Dr. Chambers. She saysshe does not know the name of the county nor the place whereshe was first taken ill. It is now a month since she was firstseized with shiverings, occurring at about half-past eight in themorning, followed by great heat and dryness of skin, and re-sulting in profuse sweating. These paroxysms last about an

hour, and come on every other morning at about the same time.The intervening days are passed without any slighter paroxysm.They have been getting more severe up to the present date.Tongue moist, and coated with a thick yellow fur ; pulse 120;skin very hot. Had an attack this morning. Catamenia re-gular up to the time of her illness. To have quinine mixtureevery four hours, and a senna draught immediately.

Oct. llth.-Two or three times during the night she burstinto a perspiration, but she has not had any shiverings. Sleptwell during the night. The spleen is enlarged, and extendsbelow the ribs for some inches, and forwards to the median line. Bowels were not moved. Senna draught to be re-

peated.12th.-Complains of pain on pressure over the spleen. Has

not had an attack this morning.14th. -Head aches; she sleeps well; has had repeated flush-

ings to-day, although no actual shivering; feels very thirsty.15th. -No return of shivering. To have decoction of cinchona

thrice a day.l8th.-Feels cold, and shivers on first rising, and has slight

pain in left side; appetite good.20th.-She has had much pain during the night. Ordered

to remain in bed to-day. The pain is seated principally in theleft hypochondrium, extending to the right hypochondrium.There is no swelling nor any enlargement that can now be feltin either region, but the pain is increased by pressing deeplyin the left. Feels cold in the morning. Omit medicines.

21st.-Pain is much less, and she expresses herself as feelingbetter. Complains of thirst; bowels not moved for fourdays.22nd.-Feels better this morning, and has very little pain

after free purgation.28th.-She is now quite well. Discharged cured.

KING’S COLLEGE HOSPITAL.

MILD TERTIAN AGUE, OF RECENT OCCURRENCE, READILYYIELDING TO TREATMENT ; NO ENLARGEMENT OF

THE SPLEEN.

(Under the care of Dr. JOHNSON.)WE have selected the subjoined example of ague from its

mild character, and because the visceral congestion was com-paratively so slight as not to produce enlargement of the spleen.The patient was treated with quinidine, and a cure followed inthe course of a few days. The notes were taken by Mr. C.H. Baines, clinical clerk :-John H-, aged thirty-nine, was admitted May 28th, 1859.

He is a native of Oxfordshire, but has resided in London fornearly the last twenty years, and has always enjoyed goodhealth, except about twelve years ago, when he had an attackof rheumatic fever, from which he rapidly recovered. He hadno palpitation nor shortness of breath, and was accustomed todrink hard.May 30th, 1859.-Pulse 66; tongue somewhat furred and

dry; rather thirsty. The bowels were freely purged by a doseof sulphate of magnesia before admission. He has been verysick, but is now better. The skin cool and perspiring; the urinenot albuminous. His illness commenced on the 24th, with achilly sensation and shivering, pain in the limbs and back,and headache. To take half a drachm of aromatic spirit ofammonia in water.June 2nd.-He felt much better yesterday, though to-day he

complains of great pain in the head, and of being generallyfeverish and thirsty; the pulse is quiet, and the skin cool,though rather dry; the symptoms seem to become more severeon each alternate day; no splenic enlargement can be de-tected. Ordered, two grains of sulphate of quinidine in dilutesulphuric acid and water, thrice a day.4th.-On the 2nd, after the visit, he had a recurrence of the

shivering. The following day he felt much better. To-day hehas more pain in the head, and feels as if he were about to beagain seized with the shivering. The quinidine to be increasedto four grains, thrice a day.7th.-About four o’clock on the 4th he felt a chilliness and

shivering, which lasted about half an hour; after the shiveringhe felt heat and pain in the head, which, he states, lasted forthree or four hours, and after that he felt very much exhausted,and fell asleep. The tongue furred and dry; pulse 60; skinmoist; bowels regular. He had no paroxysm on the 6th.9th.-His aspect is better; has had no recurrence of shiver-

ing ; tongue a little white, but quite moist; no thirst; bowelsrather confined; appetite returning. His recovery was nowrapid, and he was discharged- cured.

CLINICAL RECORDS.

UNSUSPECTED ABSCESS OF THE PROSTATE.

I Mr. THOMPSON mentions, in his work "On the EnlargedProstate," that acute inflammation of that organ is by nomeans a common affection, if regarded as distinct from and un-associated with inflammation of the urethra or bladder. It isusually observed in connexion with either of the latter, andmost probably proceeding from the one or the other. Therecan be no doubt that the symptoms of the prostatic inflamma-tion may be altogether masked by the state of the urethralmucous membrane, or even of the bladder itself. This factwas recently illustrated by the case of a patient who was ad-mitted into Guy’s Hospital on the 19th of January, in themedical wards, for retention of urine, not supposed at the timeto depend upon any other cause than defect in the con-

tracting power of the bladder. He was examined some daysafterwards by Mr. Bryant, who discovered that the patient, aman aged forty-three, was the subject of stricture of the ure-

thra, arising from a strain or injurv to the perinaeum by beingthrown across an iron bar some time previously; and an exa-mination by the rectum detected an enormous prostatic abscessfilling up the whole pelvis; it ruptured into the urethra whilstbeing examined, and a large quantity of pus passed in thatway. The retention was, at the same time, relieved; but itseems uncertain whether it mav have arisen primarily from thestricture or the abscess. The belief of llr. Bryant was thatthe abscess had arisen since the patient’s stay in the hospitalNo painful nor urgent symptom to indicate inflammation of anacute character was present before admission. and the natient