DIAGNOSIS BY EXAMINATION OF URINE IN OBSCURE FORMS OF URINARY DISEASE. BY SIR HENRY THOMPSON, Surgeon and Professor of Clinical Surgery to University College Hospital. I wish to call attention to a mode of obtaining a diagnosis in some rare and doubtful cases of disease of the urinary organs, when all other modes have failed. I described it first in my clinical lectures at University College Hospital, some years ago, as a means of observation which had never to my knowledge been recommended or practiced, and which I had adopted systematically, and which I have since found of extreme value in some exceptional instances. Thus, for example, we not seldom meet with a patient whose urine, usually containing a small or varying quantity of blood and pus, presents more or less albumen, but relative to the precise origin of which it is desirable to be certain. Some of the deposit produced is of course due to the admixture named; and while we may be right in believing the quantity to be equal only to the blood. and pus in the urine, we cannot be certain whether some of it may not be due to renal changes. In such a case, the other signs, and the symp-toms also, are often insufficient to enable us to say whether they are due solely to vesical disease or to pyelitis, or whether there may be some renal affection, not to say constitutional albuminuria, complicating the conditions named. On the other hand, the symptoms may apparently indicate only an affection of the bladder; there may be no symptom of disease involving any higher portion of the urinary tract; nevertheless, the experiment to be described may prove the kidneys to be almost solely the seat of the malady. Few cases present more of obscurity than some of those with the characters thus briefly indicated. The proceedings may be described as follows. A No. 6 or 7 flexible catheter is introduced into the bladder while the patient is in an upright position, and the urine drawn off is placed in a vessel apart. By means of an elastic gum-bottle containing a few ounces of warm water, the bladder is washed out two or three times, with about an ounce or two at a time, until the outflowing fluid is perceived to be quite clear. The catheter being left in situ, fresh urine from the kidney, untainted by any admixture, will now pass by drops into a test-tube placed to receive it; and a specimen, therefore, of true renal secretion, unqualified by vesical products, will be furnished in about five minutes, sufficing for a chemical analysis and useful to a certain extent for microscopical observation. By this simple process I have been enabled to solve the question of disease of the kidneys in some cases in which hitherto doubts as to their implication existed; and have often had the satisfaction of demonstrating that the secretion obtained direct from the organs was absolutely free from any sign of disease, where they had previously been suspected to be the seat of grave mischief. But there is one sort of fallacy on applying this test which is occasionally to be met with. An illustration of it exists at this moment in the case of a man now in my ward at University College Hospital. If the bladder easily bleed with instrumental contact, as occasionally happens, the process may produce a slight admixture of blood in the urine so obtained, barely enough to tint it, but sufficient perhaps to occasion a considerable deposit to heat and nitric, acid. It should never be forgotten, in estimating these products, that, for equal quantities of blood and pus, the former produces a much more bulky deposit of albumen than the latter. Of course, then, this disposition to slight bleeding, as a result of the procedure, and any augmentation of albumen so caused, is of itself strong evidence of vesical rather than of renal disease. I should say that the accident just named is one of rare Occurrence. -Brit. Med. Jour. Materia Medica and Chemistry. THE AFTER-TASTE OF QUININE. The Dublin Medical Press says, in practice there is often experienced a great difficulty in getting patients to take quinine, because of its aftertaste, which to some is simply unbearable, and when antipathy thus exists, combined with a difficulty in swallowing pills, the therapeutic value of an important drug is lost. We find, that the fact may not be generally known, that the mastication of some acid fruit, as an apple or a pear, will permanently remove the disagreeable after-taste of quinine. The first mouthful of fruit should be well masticated and rolled through the mouth, so as to cleanse the teeth, &c., and then ejected. The second morsel may be swallowed, when it will be discovered all taste of the quinine will be removed. PERCHLORIDE OF IRON AND MANGANESE IN NECROSIS, FISTULOUS SINNSES AND HYDROCELE, Professor Marcacci, in an essay on this subject in an Italian Medical Publication, arrives at the following conclusions. 1. Perchloride of iron and manganese, injected into fistulous sinuses, destroys the pyogenic membrane, modifies the state of the walls, and favors cicatrisation. 2. In necrosis, it acts on the confines of the living bone, stimulating its vessels, so that the detachment and separation of the dead bone are facilitated by the formation of new vessels in the living. 3. In hydrocele, it soon modifies the inner surface of the tunica vaginalis, which becomes filled with plastic exudation, attended with more or less inflammation, according to the quantity and strength of the injection used. 4. It is not necessary that the tunica vaginalis should be distended by the injection; it is sufficient that the liquid be brought into contact with all parts of the membrane. 5. Very little pain is produced by the contact of the solution, but it is not the less efficacious. 6. A weak solution is sufficient, which should be kept in two minutes. 7. In seven cases of hydrocele in which the injection was used, hard oedema followed, but was not a serious complication.-L'Imparziale, January 16th, 1871.-Brit. Med. Jour. ROYAL SOCIETY OF EDINGURGH. At the opening of the Session 1870-71, Milre-Holme, M.D., LL.D., Vice-President, delivered an able address, in the course of which he noticed the death of Fellows of the Society in the past year, dwelling naturally upon those of Professors Simpson and Syme. Professor CHRISTISON alluded to the notice that had been given of Sir James Simpson. As to the discovery of chloroform, he said the history of that had never yet been fully given. When fully given, it would constitute one of the most curious instances he knew of the gradual progress of discovery. There was one link which he thought, in justice to Sir Wil liam Lawrence, he should supply, as he could do it authoritatively. Sir William Lawrence, in the summer of 1847-the same year in the November of which Sir James Simpson made his great discovery—did repeatedly employ a solution of chloroform as an anesthetic in his surgical practice, and ascertained that it was a superior agent to sulphuric ether, Had Sir William possessed that knowledge of chemistry which Sir James Simpson very properly held that every medical man should possess, he thought there was a strong probability that he would have anticipated Sir James in his great discovery. But the article had come to him recommended by the very absurd name of chloric ether. He (Dr. Christison) rather believed there was no such thing as chloric ether known; nevertheless there was an article which had been so called. It was recom mended to Sir W. Lawrence under that name; it was tried under that name; and he was informed that both Sir William and his assistant saw that something more concentrated was wanted, and that they were busy considering how they might concentrate it when suddenly the discovery of Sir James Simpson came forth and put an end to their enquiries. Had they been aware that the substance in their hands was nothing else than a solution of chloroform in rectified spirit, the solution of their problem would have been very simple indeed. In giving some reminiscences of Professor Syme, Dr. Christison said that the reason why that eminent man returned from London was not disappointment in regard to practice. His practice during the short time he was in London was a great success. His reason for returning was, that he found himself uncomfortably circumstanced in several respects, particularly as a teacher in University College. He was finally determined to leave the metropolis by his haying been present when two of his colleagues were grossly insulted by the students at a great public meeting, and not the slightest attempt made by the Council then present, with Lord Brougham their Chancellor, at their head, to defend those professors from the insolence to which they were subjected.-Proceedings of Royal Medical Society of Edinburgh. VERATRUM VIRIDE IN PUERPERAL CONVULSIONS. In reading the proceedings of the New York Pathological Society, I was much pleased to see that the use of the veratrum viride in puerperal convulsions was meeting with much favour. For the past five years I have used it in many cases with better results than from any other course which I had heretofore pursued. But a few weeks ago I used it (not in such doses as were reported by Dr. Finnell to have been given by a homoeopathist) in a case of eclampsia, where the consulting physiciam and myself could distinctly count the pulsations at one hundred and seventy per minute, and where no amelioration of symptoms could be obtained with the use of chloroform and the other ordinary remedies in use for this grave malady. I gave Squibb's Fluid Extract, beginning with five drops, and increasing the dose one drop once in two hours until a decided impression was made upon the heart's action. Seven drops at that interval were all that was required to sufficiently diminish the pulsations to bring about the desired result. Also I wish to say a word relative to the use of the same remedy in pneumonia. For eight years past I can truly say that, with the exception of an occasional Dover's powder, I have quite exclusively relied upon the veratrum in the treatment of this disease.--New York Medical Record. BROMIDE OF POTASSIUM IN LEUCORRHEA. Dr. A. H. Kinnear reports (Chicago Medical Journal) twelve wellmarked cases of leucorrhæa, none of which were of less than six months' standing, where bromide of potassium was administered with excellent success in doses of grs. xx twice a day. Under this treatment the disease yielded in a majority of cases in one month. He also gave the remedy in a case of gleet, which resulted in a perfect cure in the course of a week. REPORT ON THE ACTION OF QUINODINE AND CINCHONINE AS REGARDS THEIR INFLUENCE ON MALARIOUS FEVERS. BY J. BUTLER HAMILTON, M.D., Assistant Surgeon, R.A., Allahabad. "In consequence of a Circular from the Inspector General of Hospitals, ordering a strict trial to be made of alkaloids other than quinine, both as prophylactics, and in the treatment of malarious diseases, the following arrangements have been made : 'Quinine in doses of 3 grs. per man per day is to be issued to all men of No. 1 Battery, 25th Brigade, and Staff Head Quarters, 25th Brigade Royal Artillery, consisting of 80 men ; quinodine and cinchonine in similar doses being issued to the men of D Battery, 16th Brigade Royal Artillery, right and left Half-Batteries, consisting of 67 men each, on an average; and all cases admitted to hospital suffering from malarious diseases are to be treated with the alkaloids allotted to the division to which the man belongs, the doses (at first) to be the same in all cases as if quinine only was used." This plan was most carefully carried out from the 3rd of August to the 16th November, 1870, under the constant personal supervision of myself; the drugs were administered daily by a careful Medical Subordinate, and were not in any way objected to by the men. The solutions of the quinodine and cinchonine were made with dilute sulphuric acid, the dose being grs. iii to loz. of water. The following are the results: QUININE. Head-Quarters and No. 1 Battery 25th Brigade, R.A.; strength 80 Admissions from Ague 78.7 per cent. of strength. men. CINCHONINE. D., 16th B., R.A. Right Half Battery; strength 67. Admissions from Ague 13=19.4 per cent of strength. QUINODINE. Left Half Battery; strength 67. Admissions from Ague 5-7-7 per cent. of strength. KK |