Observations on the characters of endemic fever in the island of Dominica : preceded by an account of the physical peculiarities of the island, so far as they influence the formation and intensity of disease / by John Imray.

  • Imray, John
Date:
1848
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the characters of endemic fever in the island of Dominica : preceded by an account of the physical peculiarities of the island, so far as they influence the formation and intensity of disease / by John Imray. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ranee in the system, which is indicated by phenomena that are familiar to tropical practitioners. A sense of fulness about the head is experienced, with a rushing noise as of water falling ; there is ringing in the ears and deafness ; sometimes nervous agitation or a feeling of slight intoxication. One or more of these symptoms are felt by the patient according to the quantity of the medicine administered. The above fact, as to the necessity of exhibiting this valuable febrifuge up to the point of saturation, is of great importance, and has, I believe, been well known to most West India medical men for several years past. It appears to be almost a necessary condition that the quinine be given till it produce some of the symptoms already noticed, to enable it to contend with and master the febrile poison ; short of this, it is much less efficacious, if not indeed powerless. It is sometimes curious to observe the struggle that apparently takes place between the two antagonistic powers. When quinine has been given during the remission in the necessary quantity, at the time the access is expected, the patient may be seized with an indescribable feeling of restlessness, unaccompanied by actual pain or febrile heat; he tosses about in bed, but can scarcely say what is the matter. In a little time this feeling goes off, and the patient is again well, or there may be a mild paroxysm of fever. The full action of quinine is not always a positive preservative from a return of the fever; it may and does very often recur, though usually in a much milder degree. Patients will sometimes remark, in rather a disappointed tone, “ I have got the fever again, though the quinine is ringing in my ears.” The manner in which I have been in the habit of administer- ing quinine, is carefully to watch the slightest appearance of a re- mission in the symptoms. If the headach and pains in the back and lower extremities subside ; if the surface, previously dry, be- comes moist; if the patient was delirious and has become sensible; from two to five grains are then administered every two or three hours; but if the case is urgent, every hour or half hour, until its usual effects on the brain and nervous system are perceived. The form of administering the medicine will depend upon cir- cumstances. It appears, however, to be taken more rapidly into the system when given in solution with sulphuric acid ; and I have sometimes thought that a less quantity was required when given in this manner. But the stomach will often reject the acid solution, and it is sometimes disagreeable to the patient. The addition of sulphate of magnesia to this solution, when it is ne- cessary to act on the bowels, will frequently be advantageous; or if judged advisable to give calomel during the remission, both medicines may be very well combined. As soon as the patient complains of deafness, noise in the ears, &c., the medicine is dis-
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