ment was undertaken in order to improve his bladder condition, and satisfactory results being obtained, in a week he was operated upon by Dr. W. F. Wesselhoeft for removal of the stone by the suprapubic route and the stone was found and removed. The accompanying pictures show the stone, as it was originally removed and also the cross section, which very prettily shows the tip of the catheter in the center of the calculus. The patient made a perfect though rather slow recovery, due undoubtedly to his general condition and age. The interesting point in this case is that the patient had used a catheter for twenty-five years and from his history had had an infected bladder for the greater part of that time, yet no stone formed until a foreign body (as the tip of the catheter) was introduced into the bladder and then in six months a calculus of this size was formed. CHLOROFORM CAUSING FATTY DEGENERATION OF THE KID NEY. From watching the analysis of the urine, previous to operation, in over ten thousand cases where anaesthetics have been administered and then watching the urinary excretion after the anaesthetic, I have decided that chloroform is far more dangerous than ether, in cases showing an analysis as follows: Normal color; low specific gravity; very slight trace of albumin; few or no casts. CASE 1. Patient, a healthy looking woman, who came in for an abdominal operation. Uranalysis was as follows: Sample. Sugar, none. Sediment. A little pus. Few squamous cells. Chloroform was administered and the patient kept under its influence for forty minutes. She rallied perfectly, but passed very little urine. The analysis of a specimen taken the second day after operation was as follows: Color, high. Albumin, large amount. Sugar, none. Sediment, considerable. Some pus. Large number of hyaline fine and coarse granular, epithelial and brown granular casts. Some blood. The patient died three days after the operation, with all the symptoms of uraemic coma. The autopsy showed that death was caused by acute fatty degeneration of the kidney. CASE 2. Patient, a man of healthy appearance, who was admitted to the hospital for an abdominal operation. Uranalysis was as follows: Sample. Color, normal. Sp. gr., 1010. Albumin, very slight trace. Sugar, none. Sediment, very slight. Few bladder cells. Two hyaline casts. Chloroform was administered and the patient kept under its influence for twenty-six minutes. He died four days later in coma, after total suppression of urine, almost since the operation. The autopsy showed that death was caused by acute fatty degeneration of the kidney. CASE 3. Patient, a woman, apparently in perfect general health. Sample. Color, normal. Sp. gr., 1010. Albumin, slight trace. Sugar, none. Sediment, slight. Bladder and vaginal epithelium. Chloroform was administered for a slight operation of fifteen minutes' duration. The patient recovered from the anaesthetic. perfectly, but passed small amounts of urine which steadily decreased till, finally, symptoms of so-called uraemic poisoning were present and death occurred two and a half days after the operation. No autopsy was permitted, but the history of suppression of urine, a stage of excitement followed by coma and death was extremely characteristic of uraemic coma and was the same history that had occurred in the two previous cases, where the autopsy had showed death to be due to acute fatty degeneration of the kidney. CASE 4. Patient, a woman who was admitted to the hospital for an abdominal operation. Uranalysis was as follows: This was to be an extremely short emergency operation, and as the surgeon decided that vomiting after the operation must be eliminated at all hazards, chloroform was used. The urine after operation grew less and less, until on the third day the total amount was 180 c. c. Color, high. All the solids diminished. Albumin, large trace. Sediment. Hyaline casts (some with epithelium adherent). Few epithelial casts. A little blood. This condition persisted for several days, gradually improving until at the end of three weeks there was virtually perfect recovery, as far as the kidneys were concerned. It will be noticed that in all of these cases, the urine was of normal color, but of a low specific gravity, contained a slight amount of albumin, and, in some of them, a few casts. We have a great many cases that have been admitted to the hospital for operation, where we get a low specific gravity, a slight trace of albumin, but where the color is pale, almost colorless at times, these analyses are from cases of nervous apprehension. What particular condition of the kidney is indicated by an analysis showing a normal color, a low specific gravity and a slight trace of albumin, may be largely a matter of opinion, and to save space I will not go into this question, except to say that where the kidneys are in such a condition that the urinary analysis shows a normal color, a low specific gravity, a very slight trace of albumin and perhaps some casts, that ether is a safer anaesthetic than chloroform, and in these cases I now recommend ether as the anaesthetic and so far without any bad results. It may be of some interest to know that we have found five cases, showing glycosuria in moderate quantities, in persons who have been sent to the hospital for operation for appendicitis, and in each of these cases the sugar has disappeared from the urine soon after the patient has been operated upon and has not returned while the patient remained in the hospital, although they were not kept on an anti-sugar diet. Among the thirty thousand urines which we have tested for sugar, in our laboratory, this temporary glycosuria has happened only in cases of appendicitis, so that I have come to look at it as being a temporary glycosuria, due in some manner to irritation of the appendix and probably a reflex disturbance of the normal liver function. In these cases no bad symptoms have appeared and the abdominal wound has healed as rapidly as is usual in appendix operations. Along this same line was the case of a child sent to the Hospital, just a short time ago, from the Out-Patient Department, with the diagnosis and symptoms of catarrhal appendicitis. The child was sent to the Hospital in order that if it might be necessary to operate, the operation could be done at once. In this case the first analysis of the urine showed sugar present, in not very large amounts. On account of the presence of only the comparatively small amount (about 30 gms.), the age of the patient, and the presence of an acute inflammatory process about the appendix, I made a diagnosis of temporary glycosuria due to irritation of the appendix and did not order an anti-carbohydrate diet. The sugar decreased very decidedly in amount as the appendix symptoms improved, and when the patient had so far recovered that she left the Hospital, the sugar was present in the urine only to a very slight degree. BICARBONATE OF SODA. INTRAVENOUS IN DIABETIC COMA. Another case which may be instructive while speaking of glycosuria is the following: A woman, about sixty years old, who had had glycosuria for quite a length of time, had an abscess in the leg which necessitated surgical interference. She had had acetone and diacetic acid, present in moderate amounts, but had not shown any tendency to coma, and was having fifteen grains of bicarbonate of soda a day. In the transfer to the surgeon, by mistake, the bicarbonate was omitted, and I was called to see her, with the history that she had been drowsy for two days and totally unconscious for the past twenty-four hours. She was unable to swallow and was in a deep coma. She was given an intravenous of a pint of normal saline with five grains of bicarbonate of soda and in six hours she was given another five grains in a pint of normal saline, in the other arm. The next day she was able to swallow and the day after (the bicarbonate of soda having been pushed by the mouth) she could be roused from her coma; she ultimately became perfectly rational and was able to be taken outdoors. I lost sight of her at that time, but understand that she died a few months later. I also gave ten grains of bicarbonate of soda in one pint of normal saline, in a case of mixed autointoxication of urea and hydroxybuteric, where vomiting had gone on to complete exhaustion and no medicine could be retained by the mouth. The vomiting was promptly and decidedly helped, but on account of the mixed infection I later had to use other means also. I am reporting this case more fully in another article. A NEW METHOD OF TREATING DISEASE.* W. H. WATTERS, A.B., M.D., PROFESSOR OF PATHOLOGY, BOSTON, MASS. Mr. Chairman and Members of the Worcester County Homeopathic Medical Society:-In honoring me with the request to present to you a paper, you doubtless expected that as a laboratory worker I would select some topic bearing directly along laboratory lines. This I have done, but have tried to diverge somewhat from the abstruse subjects often treated and to bring to your attention something comparatively new, something that bids fair to become of increasing importance. With the notable exception of diphtheria and a few other diseases, the laboratory has in the past furnished us with little information concerning the exact treatment of disease, however much it has advanced our knowledge of the nature of almost all diseases and their phenomena. Very recently much has been heard concerning a new method of treatment apparently of wide application and requiring careful laboratory observations for its successful accomplishment. *Read before the Worcester County Homeopathic Medical Society, February 13, 1997. |