Part 6

In order to be able to make an exact diagnosis, it is necessary to examine carefully, both the urea and the other excreta, for several days consecutively. As a rule, persons attacked by simple polyuria, or who are suffering from interstitial nephritis, beginning with polyuria, do not present the symptoms which we have enumerated.

Disturbances of the nervous symptom and alcoholism claim the first place in the etiology of this affection, and indicate the treatment which has to be adopted. It consists in administering drugs to calm the nervous erethism (opium and valerian), and to put a stop to the excessive and progressive impoverishment of the tissues (arsenic, a suitable diet, etc.) Valerian has proved specially successful in different cases, even effecting a complete cure. Besides these cases of azoturia, combined with polydipsia, Bouchard thought that there was another form of the same disease, in which there was no abnormal excretion of urine, although the latter contained an excessive amount of urea. However, as his observations in that respect are far from being satisfactory, and as these are evidently cases of cachexia, the etiology of which is very obscure, it will be wiser to leave them alone for the present. The author then goes on to consider the much-debated question on the varying amount of urea in glycosuria. In some patients suffering from the latter affection, as much urea is eliminated as the general amount in azoturic patients. It is true, however, that there may be something more than a simple coincidence between these two affections, and several authors have tried to link them together. Lécorché, who admits the hepatic theory of the formation of urea, thinks that this is only the double result of hyper-activity of the functions of the liver. Bouchard, on the contrary, considers it as a true complication of the existing affection, where troubles of nutrition are added to those resulting from insufficient respiratory combustion. According to him, the difference between melitæmia and azotæmia consists in the first resulting from the accumulation of a product of secretion, while the second results from the accumulation of a product of secretion. Azoturia is, therefore, as we said, only a complication, an accessory element which must, however, be considered as being a most important prognostic symptom. According to the same author the abundance of sugar in diabetes is owing more to a want of combustion than an exaggerated production of this substance in the organisms. If this be the case, how can we explain the coincidence of an abnormally low temperature with the production of an exaggerated quantity of urea, such as has been observed in every case without exception? This is the weak point of M. Bouchard’s theory, and it would perhaps be better to refrain from giving a decided opinion on the subject until it has been more thoroughly studied. In short, whenever there is an excessive excretion of urea we may consider it as a symptom of incipient cachexia, followed by loss of flesh. The most important question, however, for the medical practitioner is the following: are these two affections to be considered as belonging to two different groups, but having been developed incidentally at the same time in the same patient; or are they connected through a link which is still unknown to us, thereby forming one affection or disease? If these questions could be solved, there might be some hope of discovering some rational mode of treatment, so as to prevent albuminuria from setting in, in which case all is lost. In another chapter we find the calculation of the amount of urea excreted in several chronic diseases, such as obesity, syphilis and athrepsy. Here it is easy to make a mistake, and still more so to err in trying to interpret the results obtained, because here the nourishment taken by the patient plays an important part, which is easily overlooked, e. g., in fleshy persons. Azoturia may be produced either by excess of food, or by abstaining from farinaceous food. The only way of ascertaining if the combustive functions are really exaggerated in a patient would be to compare the amount of chlorates contained in the secretions with the weight of the patient. Since Brouardel published his paper, on what he termed the uropoietic functions of the liver, several experiments have been made to ascertain the amount of urea excreted in diseases of this organ. The results have been very contradictory, but it is certain that large quantities of urea have been found in the urine of patients whose liver was completely degenerated.—_London Medical Record._

EXPERIMENTS CONCERNING ERYSIPELAS.

Observations “were undertaken” by H. Fillman, of Leipzig, “in order, if possible to obtain further and more accurate information upon some contested points regarding erysipelas.” The experimenter has addressed himself here, especially to the answering of the four following questions:

I. Is it possible to convey erysipelas by inoculation from a diseased to a healthy individual? In other words, do those fluids obtained from the tissues of an erysipelatous part and employed for inoculation (_e. g._, lymph, blood, the contents of bullæ, pus, etc.,) exercise a specific, _i. e._, contagious action on healthy individuals when inoculated, or do they not?

II. What is the action of carbolic acid upon those erysipelatous animal fluids which produced the same disease on being inoculated into healthy individuals, and therefore in all probability contained the erysipelas poison?

III. In what way is it possible (apart from direct conveyance) to produce erysipelas in healthy animals by the application of different morbid matters?

IV. What do we learn from the results of anatomical and experimental investigation regarding the presence and significance of bacteria? What relation have they to erysipelas?

It would be difficult for four more interesting or important questions for the practical and scientific surgeon than these. But in proportion to their importance are the difficulties which surround them. These, however, are grappled with by the author courageously, patiently, and honestly, and the result is at all events a series of experiments of extreme interest, whatever be the conclusion, we may feel disposed to draw from them. Indeed, the writer himself seems to have set out upon his investigation purely with the desire to learn whatever is to be learned on the points stated, by careful and patient anatomical research, and without being wedded to any particular theory in regard to them, or desiring to force any conclusion.

Recognizing the great importance of the subject, and the efforts that have been made by others in the same direction to throw light upon it, notably by William, Ponfick, Orth, Bellien, Zuelzer, and Lukomsky, he has recognized many points in which these observers have failed, and has endeavored, in following out somewhat similar lines of research, to avoid their, and other, errors.

To the danger of one great source of possible error the author seems specially alive, the introduction of other matters into the system of the animal operated on than the mere morbid fluid inoculated, and this he has endeavored to guard against by the most scrupulous cleanliness in obtaining, preparing and introducing such fluids into the bodies of animals.

In touching upon the first question his first case is to define as clearly as possible what are the clinical features which characterize erysipelas in the human subject. He then details in all his experiments, and, from the kind of success of five out of twenty-five inoculations he believes there can be no doubt “that erysipelas is inoculable in rare cases; that fluids from an erysipelatous part, display a specific contagious action.” In three cases he inoculated animals from the human subject successfully with erysipelas, and in two cases animals were infected from other animals. He believes, too, that one human subject might be inoculated from another.

In regard to the second question propounded, four experiments were made with erysipelatous inoculation material, which had been potent in other cases, but here a portion of 2–4 per cent. solution of carbolic acid was added. In none of these cases was there any appearance of either local or general symptoms of any disease.

In answer to question III, all the author’s results were negative. In no case was erysipelas produced by even the most putrid inoculations, when they were not taken from an erysipelatous part. In several cases, however, the animals died of distinct septicæmia.

The observations on the last point which are related in detail, point to the conclusion that bacteria are present in some cases of erysipelas and absent in others, so that we may infer that the advance of the disease does not depend upon their presence.—_London Medical Record._

CHOLERA INFANTUM.

A contribution to the etiology, pathology, and therapeutics of cholera infantum,[4] by Dr. T. Clarke, Miller, opens fairly and clearly a theme which will be uppermost in the thoughts of physicians in the approaching hot weather.

The writer begins by pointing out how differently the name _Cholera Infantum_ has been applied, including every phase of choleraic diseases. But, “Classification of these diseases to be practical, must of necessity be rather coarse in order to adopt itself to the grain of the great mass—the rank and file—who in the main observe well, though not so systematically as we could wish. The great office-workers do not contribute largely to our mortality statistics, but we will derive great comfort as we proceed, in finding that the figures of these common men are stupendously significant—that the bullet and bayonet are in the aggregate little less important than the epaulette and the gold lace.” He supposed that in the large majority of cases reported as cholera infantum that the choleraic feature was present at some time during the illness, though very likely not at or very near the time of death. For these reasons he considers that the statistics presented are not materially impaired.

“The onset of cholera infantum is characterized by copious watery evacuations from the bowels, often attended by nausea and free vomiting. Attending upon this or even sometimes preceding it, or rapidly succeeding upon it, is the extreme muscular prostration and great depression of the respiratory functions; there is generally more or less griping pain and restlessness, and a rapid appearance of all the symptoms of collapse, coldness of the surface and tongue, feeble rapid pulse, and partial or total loss of voice. Cholera infantum proper, lasts but a few hours—hardly a few days—when it ends in recovery, death, or inflammatory disease of some portion of the intestinal tract; in the latter case the choleraic disease is rapidly rekindled by conditions similar to those which brought about the first attack.

“The condition under which cholera infantum appears, and the _only_ condition essential to its development, is continued high temperature day and night—a mean thermometer above 75°, with small daily range. This high and slightly varying temperature continued from six to ten days, will invariably, in our climate, bring cholera infantum (together with the bowel trouble symptomatically more or less distinct, but pathologically akin to cholera infantum), and the longer this condition of things continues the more numerous and the more intractable the cases become. This is as true in the country as in the city, though we are led to think, as we read the books, that this is a disease of the city especially. Deaths are registered, to be sure, and the books are made in the cities, but if the conditions above mentioned exist in the country, the disease appears there—of course, not a great many cases, for the susceptible bodies furnished by a single block in the city would outnumber those of two or three square miles in the country—yet I am glad to admit that the _conditions_ for obvious reasons are not so likely to be present in the country; the contrast, in point of green grass, shade, cool water, and moving air, is no less marked than is the percentage of mortality, and it is _no more_ marked.

“Few, if any, recoveries take place until the temperature falls; this fall is usually attended by rain; but this does not seem to be essential, the fall of temperature alone being sufficient to bring about a better state of things. When the temperature falls, cases improve and new cases cease to appear. Sewer emanations do not seem to have anything directly to do with the production of disease, except so far as they tend to impair the general health, and thus diminish the power of the system to resist any disease producing influence, and sewer poisons are no less abundant and deadly at other times than they are when cholera infantum cases are most numerous, and this is the time of year above others when the sewers are abundantly ‘flushed.’”

Filth he does not consider is any more abundant in the summer, and the disease declines with the increase of the very rains that favor increased decomposition. He does not attach much importance to unripe fruits as a causative element. “For whoever saw a youngster who would not exchange all his earthly possessions for a green apple, and whoever saw a child in good health injured by an unripe apple or by any quantity not altogether unreasonable?” And then the sufferers from cholera infantum are all under two years, and hence have not arrived at the green-fruit eating stage of their existence.

Nine tables are constructed, showing the weekly mortality from cholera infantum in Philadelphia, New York, Boston, Baltimore, Cincinnati and Chicago, and also as far as possible the record of thermometric range. An analysis of the table bears out the author’s views as regards the causative influence of continued high temperature.

He thinks there are some points of striking resemblance between this disease and sunstroke, so much as to suggest a pathological relationship. 1st. The same conditions seem to be sufficient for and essential to the development of each. 2. They come and go together. 3. The development is gradual and the recovery is slow in each, showing a profound impression made on the living-power of the patient. 4. The explosive character of the attack under the cumulative effects of continued high temperature with the sudden severe or fatal prostration consequent.

“Wash your children well with _cold water_ twice a day, and _oftener_ in the hot season,” is the direction of the New York Board of Health, and Dr. Miller thinks if this one prescription were carried out, cholera infantum cases could be well nigh eliminated from the mortality reports. He thinks it worth while to inculcate among our patrons that however important it may be to take special care in feeling, this will not be sufficient alone, to carry the infant safely through the high temperature of July and August; and we would try to have the people study to keep the little ones _cool_, and the means recommended is cool-bathing or cool-sponging. Medicines are not of much use if the surroundings are cool.

SOCIETY MATTERS.

The subject selected by the Medical Society at the last meeting in Goldsborough, was SPONDYLITIS. They were fortunate in selecting Dr. M. Whitehead as the essayist. It seems to us it would be more agreeable to the essayist, to allow him to select his own theme, and provided he announced it in advance of the meeting, it would answer the same purpose.

The annual oration will be delivered by Dr. W. W. Lane, of Wilmington, upon a subject not announced.

The Society expects from these gentlemen rare entertainment and instruction.

* * * * *

In our quotation from the _Nation’s_ Berlin letter on “The Discovery of the Soul,” the printers made the mistake of not ending the paragraph with quotation marks, and our northern neighbors who copied it from the Journal entire without acknowledgement, have incorporated Sambo’s philosophy in a way that we considered original with ourselves. It would be news to the _Nation’s_ correspondent that he is versed in the mysteries of the philosophy involved in the “folk lore” of our Southern negroes.

TO OUR READERS.

THE VALUE OF PURE WINE IN SICKNESS.

The chief difficulty with reliable wines has been their scarcity and exorbitant price, but this has been removed by the introduction of a Pure Native Wine, produced from the Oporto grape by Mr. Alfred Speer, of New Jersey. We understand he has submitted his Wine to the test of many of our celebrated physicians, and all concur in its purity, medicinal properties, and superiority to the best imported Port Wine. Most of them prescribe it in cases of debility, affections of the kidneys, and chronic complaints, requiring a tonic, sudorific or diuretic treatment.—_Examiner._ Salesroom 34 Warren street; N. Y.

MALTINE.

This above preparation is attracting the attention of the medical profession of Great Britain and the reputation it has acquired as one of our best nutritive agents is recognized and established, as the following extracts will show:

From the _British Medical Journal_, October 10th, 1878:—“At the late meeting of the British Medical Association, at Bath, in August last, among the visits of Pharmaceutical and Medical preparations, much interest was shown in one called _Maltine_, which may be described as a highly concentrated extract of _malted barley_, _wheat_ and _oats_.

“Extracts of Malt (i. e., Malted barley) are pretty widely known, but this is the first example of a combination of the nutritious principles of these three cereals that we have seen, and the greater value of this combination is apparent, as wheat and oats are especially rich in muscular and fat-producing elements. This preparation is entirely free from the products of fermentation, such as alcohol and carbonic acid, and is very agreeable to the taste.

“Clinical experience enables us to recommend it as a nutritive and digestive agent, in virtue of its albuminoid contents, and its richness in phosphates and diastase, likely to prove an important remedy in pulmonary affections, debility, many forms of indigestion, imperfect nutrition, and deficient lactation. It will in many cases take the place of Cod Liver Oil and pancreatic emulsions, where these are not readily accepted by the stomach.”

From the _Medical Times and Gazette_, November 2d, 1878:—“We have received a sample of a preparation called Maltine, which is described as being a concentrated extract of _malted barley_, _wheat_ and _oats_. It is prepared with great care by a process fully described by the manufacturers (Reed & Carnrick) in a pamphlet which they will, we believe, willingly supply to any medical practitioner. The preparation possesses many qualities of great importance. It is non-alcoholic; it is agreeable to the taste; from its being so concentrated it is more portable than the liquid known as Malt Extract; and it possesses the virtues of that preparation in a much higher degree, inasmuch as it combines the principles of the three cereals above named, and wheat and oats are especially rich in bone, fat, and muscle-producing elements. We have very good reasons for believing that it has been very carefully analyzed and examined by a competent authority, and proved to be very rich in diastase, in phosphates, and in albuminoid matters. It is very likely, therefore, to have considerable value as a digestive and nutritive agent in many wasting diseases, and cases of debility and imperfect assimilation. _Maltine_ at any rate is well worthy of being put to the test practically by medical men, and it may be taken pure or mixed with water, wine or milk.”

UTERINE DISEASES.

By E. H. MURRELL, M. D., Lynchburg, Va.

It has been asserted that life is the most mysterious problem in nature, and that its duration is circumscribed by the laws of disease; consequently the incessant conflict which is waged between health and its insidious destroyer can never cease, but will ever continue to engage the attention of the chemist and pathologist in their profound researches of the best means of its preservation. Therefore, we need not be amazed or inquire why it is that the power of preserving life is held in such high estimation, or that the loss of it should be deemed a private misfortune or a public calamity.

Whatever may be the cause of constitutional debility and whenever prolonged, it must of necessity impair the healthy nutrition of the tissues, and lead to a low, inflammatory condition of the mucous membranes. The uterus and its appendages constitute no exception to the general rule, for whenever inflammation is lighted up in this organ, functional disturbance, accompanied by ulceration and hypertrophy follow as a natural consequence. On the other hand, it has been clearly demonstrated that constitutional debility of the gravest import and prolonged duration has its origin in those causes which induce sanguineous and muco-purulent discharges, continued pain, great despondency, and a general inability to partake of the accustomed food and exercise.

In the consideration of uterine diseases, including leucorrhœa, dysmenorrhœa, suppressed catamenia, menorrhagic and vaginal inflammation, it is proposed briefly to allude to the efficacy of the Bedford Alum and Iron Springs Mass as a curative agent, and to call attention to its tonic properties, which act most beneficially in their healthful restoration. By reference to the analysis of this Mass, it will be seen that it contains all the constituent properties most essential to the relief of morbid disease, namely by restraining the secretion while combining the tonic properties alike conducive to the improvement of the circulation and removing the causes which influence constitutional debility. For this reason, the water appears to exert a specific influence over the female organism, and often displays its wonderful power of relief after the unsuccessful employment of all other remedial agents.

A brief synopsis of the treatment of suppressed catamenia by the Bedford Alum and Iron Springs Mass which came under the immediate attention of the writer, will suffice to attest its virtues:

Miss. J. S., a resident of this city, aged 20 years, of delicate constitution; had for months suffered from suppression of the catamenia which resulted in anæmia and great emaciation, attended with extreme nervousness, loss of appetite, constant cough, pain in the chest, night sweats, closely bordering on phthisis pulmonalis. After the exhaustion of numerous emmagogue agents which had been employed for months unsuccessfully, medical counsel was sought, and apparently with little hope of recovery. She was at once placed upon the free use of the Bedford Alum and Iron Springs Mass, which was continued for the space of three months, at the expiration of which time all organic disturbance was removed, with a complete subsidence of the symptoms before detailed, and a perfect restoration of her health, which has continued unimpaired to the present date.

Other cases might be adduced in testimony of the great efficacy of the Bedford Alum and Iron Springs Mass in the treatment of uterine diseases generally; but enjoying as it does so largely the public confidence and endorsed by the well-tested experience of the medical profession, any additional evidence in support of its virtues and wide-spread reputation would only prove superfluous and uncalled-for by the most skeptical.

OBITUARY.

ISAAC HAYS, M. D.

Dr. Isaac Hays, editor of the American Journal of Medical Sciences for 52 years, died in Philadelphia, Saturday, April 12th, 1879, 83 years of age.

WILLIAM A. DICK, M. D.