« ForrigeFortsett »
urine. (3) Intermittent fentosuria, occur. selves, and for some time there had been a ring when the excretion of pentose takes tendency to diarrhea. The hematologic explace at more or less regular intervals unin. amination presented the following: Red blood Auenoed by external oonditions and when one corpuscles less than 4,000,000; the bemaglohundred grams of glucose will not give rise bin amounted to 70 per cent; tbe leucocytes to a glycosuria. (4) Intermittent pentosuria were above 10,000. The blood, save tbat of a and glycosuria. When this condition occurs slight secondary anemia, was otherwise nor. pentose is present in appreciable quantities, mal. The physical examination was nega. and glucose appears in the urine, either inde tive. A bacteriologic examination of the pendently or after the administration of one blood gave a pure culture of bacillus coil hundred grams of glucose.
communis. The condition, therefore, belongs The Influence of Excessive Meat Diet on
to the group of affections often termed false Growth and Nutrition. - Watson's (Lancet,
cyanosis. July 21. 1906) paper deals with the clinical Tuberculin in the Treatment of Tuberculo. results obtained by feeding rats on an exclus. sis.-Pogue (Med. Record, Aug. 4, 1906) deive meat diet. His experiments prove that ducts the following conolusions from a study the use of such an excessive meat diet is at- of 167 cases: An early diagnosis is the most tended by a retarded growth, and sterility is important step to the successful treatment of induced if the diet is commenced in early tuberculosis. Tuberculosis may be arrested life. The power of lactation is diminished by proper treatment, with a certainty of a a permanent weakening of the resisting power permanent cure. Tuberculin is a valuable of the animals is induced by the use of excess- adjuvant in the treatment of tuberculosis, as ive Aesh diet in early life, the animals suc. is evidence by the recovery of twenty-eight cumbipg to disease at an unusually early age, out of thirty cases that were treated with and there is a high death rate in the offspring practically nothing but tuberculin wbile they of animals fed on excessive meat diet. Clin. continued to follow their ordinary occupation ical experience leads Watson to think that during the treatment. Cases of tuberoulosis there is also a close parallel in diseases of the treated witb the addition of tuberculin show a human subject, and especially in that class of much less tendency to recur than similar affeotions commonly included under the terms cases treated without tuberculin. Tuberculin of gout and goutiness. He mentions that in small doses (0.01 to 0.005) seems to bave particular attention should be given to early a more curative action than when given in dietetio bistory of patients as far as obtaina. large and increasing doses. No ill effects fol.
low the administration of small doses of
tuberculin. Purely incipient cases improve A Simple Test for Biliary Pigments in the very rapidly under the use of small doses Urine.-Krokiewicz (Bulletin général de ther- of tuberoulip, botb as to the arrest of the apeutique, May 23, 1906) recommends a test disease and the clearing up of the diseased consisting of aqueous solutions of sulpban area. Tuberculin should never be given ilic acid (1 per cent) and sodium nitrite (1 to a patient who has a fever or who is suffer. per cent) as highly sensitive for bile pig. ing from mixed infection. Third stage cases, ments in the urine, and tbat its application, especially advanced cases, receive little or no is not affected by the presence of other sub. benefit from the use of tuberculin. stances. The test is carried out as follows: Equal quantities of the sulphapilio acid and
The Loss of Patellar-Reflex in Pneumonia. sodium nitrite solution (1 co.) are placed in a - Barnes (Birmingham Med. Review, April, test tube, to which an equivalent quantity of 1906) like Hughlings Jackson, observed a loss urine (1 cc.) is added. The mixture is of knee and other reflexes in cropuous pnen. shaken for ten or fifteen seconds, and if the monia, while in pulmonary consoildations urine contain bile pigment the solution will due to tuberculosis and septic pneumonias become a ruby red, which upon the addi. the reflexes invariably persisted until death. tion of one or two drops of bydrochloric He noted an absence of the patellar reacid changes to a violet amethyst.
flexes in thirty out of thirty-four cases of
croupous pneumonia. A disappearance of Microbic Cyanosis.-Gibson and Douglas the knee reflex on the first or second day (Lancet, July 1, 1906) relate an interesting generally indicates a severe attack with a bad case of a woman, 36 years of age, who had termination. In those cases which ended been subject to headaches, weakness, attacks fatally, the author was able to demonstrate of dizziness and faintness for some years changes in the third lumbar segment. Barnes The appearance of the skin was of a dis believes that the absence or presence of the tinctly cyanotic tint. Gastric as well as en- knee reflexes is not only a valuable differenteric disturbances frequently evidenced them- tial sign, but also a guide to the prognosis.
2. Procce çer. Maratter (Voir
DEPARTMENT OF LEGAL MEDICINE. system of the chest is enormously distended
with blood, much more so than can be acR. B. H. GRADWOHL, M. D.
counted for on the basis of a post mortem fillDeath from Electricity.- Kratter (Veir. ing by gravity; this is not an artefaot, but teljabroschrift fuer Ger. Medizin, Band is found in every case of death by asphyxia XXX Heft 2, Proceedings of the German as well as in electric deaths. As Kratter said Association of Legal Medicine) has con before, “death by electricity is a central restributed several monographs upon the subject piration paralysis, a special kind of internal of death from electricity. He opened the asphyxia.” discussion of this subject anew at this con. What changes take place in the central vention by dividing the subject into three nervous system as to lead to death by asheadings, viz. : 1. What is death by electric- phyxia was the subject of an inquiry by ity? 2. How can the diagnosis of death from Kratter; he made sections of the spinal cords electricity be verified ? 3. Which ourrent can of two subjects, one human and one experi. kill a man?
wental animal, dying from the electric Knowledge can be gained of the fact that stream. He made out minute hemorrhages. death is caused by the electric current by the Corrado found in the brains of dogs killed many deaths of persons and animals by acoi. with the current decided changes in the gândent and the pathologic-anatomic changes glion cells of the cortex. These changes were found in them; secondly, by experimental in the shape of distortion of the nuclei and researches upon animals with this current. chromatin substance and vacuole formation. Death ocours suddenly in some, sometimes There was a condition of varicose atrophy. with an outory, sometimes without it, with Kratter is unable to confirm Carrado's find. only tetanio-like convulsion of the body, with. ings. Neither can Jellinek confirm the same, out leaving any visible traces upon the out. although he has made many sections of aniside of the body. In other cases death does mals dying from the current. not occur immediately, there is loss of con. In short, Kratter inquires, “Can we accur. sciousness, u soporific effect of the current, ately draw a picture of the pathologio anadeath finally taking place with sterterous tomic findings in a case of electric death and breathing and gradually increasing cyanosis. make a diagnosis thereon ? He replies, that In experimental animals where naturally ob- we cannot and for the following reasons: 1. servation can be more acute, there is remarked The peculiar character of the current and a difficulty in breathing at first, followed by laok of control over the same makes it imconclusion of the entire muscular system. possible to reason on one case from all cases. The breathing difficulty is either permanent It is a fact that much more severe changes (death), or begins after a quarter, a half or than are found in cases of electric death an entire minute, and gradually is restored. are produced in the brains of men who rally Jellinke bas observed other phenomena; at survive. 2. Experiments and clinical cases the moment of contaot, there is a spasm of of electric shock show us that reparable effects the entire circulatory system, with an enor- are sometimes produced by the current from mous inorease in the blood pressure, this go- wbich the animals recover. ing far to explain the hemorrhaes which have It is a fact that while the anatomio diag. been described in some cases of electric nosis cannot be distinguished from that of shock. This can be determined by the spby. “shock" in the ordinary expression of the mographio tracings, which show that if the term, as regards the effect upon the internal breathing stops for any long period of time, organs, yet fortunately the effects of the there is a sinking in the blood pressure, with current upon the exterior of the body serves Aluiost impreceptible movement of the pulse to make a competent diagnosis, i, e., the and very slight palpable beart's action. This effects of burns either from lightning or is the picture of an asphyxiation.
from actual electrio shocks from motors, etc. The anatomic picture found in these The burns produced in industrial accidents cases does not differ either in man or in ani. are characteristic; a long blister usually upon mals. The blood in the body is very fluid, the index finger of the band receiving the or with very slight clots in the bodies of ani. shock. Other means of diagnosis depend mals, of a dark color, over-filling of the lungs upon the point where the shock was received and heart and great vessels with blood, many in the body, burning and tearing of the ecohymoses visible to the naked eyes in clothing, foot or bead apparel, in lightning places in the body, just as we find them in deaths burning and melting of metallio subdrowned bodies. In one case Kratter found stances like watches, watoh.chains, etc., on ecobymoses under the endooardium of the the body, and magnetization of iron subleft heart, as Dietrich has pointed out in stances on the body, such as knife blades, cases of death from sun-stroke. The vengus keys, etc.
As to the third question, what kind of a urea. Disturbances of the kidney and liver, current can kill, there arises an important Croftan states, often are seen to go hand in question, theoretic as well as practical. It band, and he believes this would be found can be accepted as a fact that a current with much more frequently if the liver were exama voltage of 500 is dangerous, and the dan. ined as thoroughly as the kidneys in every ger increases as we go over the 500 mark. case of Bright's disease that comes to au. Tbis rule varies with individuals as a rule, topsy, and if mild functional disorders of the For instance, men have been killed by a cur. liver were as easily recognizable as like disrent of 250 volts and others have survived a orders of the kidney. Even if the kidneys current of over several thousand volts. It is are primarily share the function of eliminata well-known fact that currents of 20 milli. ing toxio matters and some of the most imamperes are used for medicinal purposes. A portant of these must pass through the liver current of 100 M. A. is a dangerous. Mois- before being finally eliminated by the kid. ture of the skin increases the effect of the peys. Even if the kidneys are primarily discurrent, as well as salt solutions and acid so eased more work is thrown on the liver, not lutions opon the skin.
only in its disintoxicating function, but also The idiosyncrasy of certain persons to the in making up for the waste caused by a leaky current must not be forgotten. Alooholics, kidney. The organ consequently becomes patients with heart disease and lympbatic fatigued, its fonction of disintegration of al. trouble, as well as youthful people in general bumins is impaired and less urea and more are quite susceptible to the current. Alter- incompletely disassimilated intermediary pronating ourients are more dangerous than the duots of albuminous metabolism are thrown direct.
into the circulation and intoxication results.
Though this may thus follow or accompany GENITO-URINARY.
renal disease, it is still due more to hepatic
than to renal insufficiency. Hence the im. T. A. HOPKINS, M. D.
portance of recognizing early even mild de. An Analytical Study of Uremia.—Dr. A. grees of hepatic insufficienoy (particularly C. Croftan, Chicago (Jour. A. M. A.), oriti. in renal cases and in pregnant women) and cises the current theories of uremia, showing of safeguarding the patient against any. that neitber anuria nor the variations of ex. thing that may suddenly impose a strain on crementitious nitrogen output suffice to ex- the fatigued liver. Instead, therefore, of plain the phenomena. Only when we de- stimulating the kidneys, the chief object of termine separately the various groups of ni. treatment should be to prevent development trogen bodies that occur in the blood and of uremia by attention to those organs that urine do we find abnormal conditions tbat threaten to fail. Croftan advises first rest may be deemed fairly characteristic. The for the liver, even starvation for a few days, two most important of these are: 1. A rela and in any case complete elimination from tive increase of the ammonia salts, both of the diet of all substances irritating to the or. the blood and urine as compared to normal gan, and that every effort should be made to average values and as compared to the circu. reduce intestinal putrefaction to a minimum, lating and excrementitious urea. 2. A rela. He would follow this by mild stimulation, tive decrease of the urea, both of blood and the carefully guarded use of salicylates, of urine as compared to normal average values bile acids, possibly of calomel, and such dieand to the total nitrogen of the circulating tetic and physical means as are available, all and excrementitious nitrogenous waste prod under careful supervision. For the acute uots. There may also be highly toxic albu. uremic attack the most sensible procedure, he minoid or alkaloid bodies in the blood or says, is blood letting, a lost art that should urine that might have an enormous effect be revived in such cases as these. The injecwithout appreciably changing the amount ortion of a saline to replace the lost fluid can relative proportions of the nitrogeu content. do no barm, especially if some salt is injected As regards the inorganic salts, the most deli. that can stimulate the hepatio function, e.g., cate tests, Croftan states, give little evidence salicylate of soda in normal salt solution, or that uremia is due to salt retention. That a solution of sodium citrate or phosphate in there must be some poisons acting in the proper molecular concentration. Sympto. productions of uremia can not be denied. matically, he has seen good results from the The decreased urea secretion, Croftan is in use of such infusions. clined to think, is due rather to non-formation than to retention. It is not increased in The Rational Treatment of Urethritis.the blood, as it should be if it were merely N. E. Aronstam M.D., Detroit, Mich. (Jour. not eliminated, and the corresponding in- A.M.A.), condemns the so-called abortive crease of ammonia is normally concerted into plan of the treatment of acute urethritis and also the so-called expectant plan of treatment. tion of the seat of the lesion. The three-glass Not less reprehensible, he states, are the reme. test of the urine should be used, and sound dies in vogue at present, prominently among introduced to detect strictures and diverti. these, figure the alkaline diuretics." The oula. Rectal examination is imperative in author claimes that alkalies wben absorbed nearly all cases, ard search must be instituted are completely destroyed as far as the acid for possible diseased conditions of Cowper's radicle is concerned, being converted into glands as this is apt to cause an obstinate normal chlorids or salines and not carbonates, uretbrorrhea. Follioulitis of the urethral and he states that they exert beneficial effect mucosa may produce a mucopurulent dison the inflamed uretbra, not as alkalies, but charge. Meatotomy and circumcision as diluents and diuretics. The therapeutics should be performed in proper cases. Affecvalue of boric acid and salol is also doubtful; tions of the bladder, ureters and pelvis of the balsamics are condemned, presumable benefit kidneys or of the kidney itself must attract from these remedies being due to the water attention as possible causes in all ultrataken in them. In the acute stage the pa- chronic cases. Cystoscopy and, if necessary, tient should take plenty of water, avoiding ureteral catheterization should be performed alcohol, tea and coffee, and condiments as before definitely arriving at a diagnosis. In well as soups and nitrogenous foods. The conclusion the author remonstrates against anterior urethra is Ausbed with a normal sa- upscientifio inethods of treatment and the line solution by means of the Valentine failure to recognize the gravity of gonococ. douche or similarly devised apparatus, with cio urethritis. The treatment undertaken a good valse attachment to regulate the flow. by the physician must be in conformity with The apparatus should not be elevate higher the most modern principles governing it. than six feet. The uretbra having been cleansed, 20 minims of a solution adrenalin Some Observations on Prostatectomy.-L. (1:1,000) is instilled through an ordinary Bolton Bangs (Med. Record) considers the bulb eye dropper into the capal, retained five following factors in deciding whether or not minutes and allowed to escape. . The saline to advise prostatectomy; the general condiirrigations are continued once or twice daily tion of the patient, bis social condition and for ten days, after which potassium perman- environment, his temperament and his accessi. ganate is substituted in ascending strength, blity to judicious medical advice and assist1:10,000 to 1:1,000 at the end of the third ance; whether or not catheter life is likely to week. By this time the discharge will have fail, and, if it has failed, in what degree; and, ceased, or nearly so, and a prescription of finally, what measure of relief is to be gained zinc sulphate, adrenalin and colorless fluid if, after the operation, some imperfection extract of hydrastis in distilled water may should remain which is insignificant in combe used, whicb, in a short time, will check it parison with the prior condition. The writer completely. Three weeks suffice in the ma. then gives the histories of a number of pajority of instances to effect a cure. The treat- tients which show how often significant ment of the chronic form of urethritis is symptoms are appreciated or overlookled. He more difficult, tedious and complicated than speaks of certain cases in which small prosthat of the acute variety. The author rec- tates have been removed when there were few ommends as an injection a solution of pro- or no signs of obstruction. In these cases it targol (5 per cent) together with adrenalin was not recognized that chronic interstitial chlorid and Magendie's solution of morphine cystitis bad reduced the capacity of the blad. if necessary. In some cases silver nitrate der so that frequent urination had become a acts more favorably than other silver com necessity. Each case must be studied by itpounds. Irrigations with potassium per. self. The final outcome of the operation canmanganate or zinc sulphate may be useful not be foretold definitely, but when the inThe introduction of sounds is indicated: dications are clear it can be wisely advised first, in incipient and formative stages of on account of the great relief and comfort stricture; second, in involvement of the pos which result. terior urethra without implication of its adnexa; third, as a powerful stimulant to the uretbra in catarrhal treatment affecting its
In protracted cases of summer complaint anterior segment, where no gonococci are
give fresbly pressed grape and other juices demonstrable. The author recommends uretbroscopy for table practice as a means of
to prevent scurvy. diangosis and as a therapeutic auxiliary. The For toothache nothing is better than oil value of internal treatment in ohronio gono. of cloves and tincture opium, equal parts, apcoccic urethritis is questionable. The proper plied to the aching tooth on a pledget of cot. treatment in all cases depends on determina. ton, says Dr. J. L. Fennel.
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chemical and synthetic and Galenical prepMEDICAL MISCELLANY
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trums which from time to time are offered to LEPROSY HOSPITAL IN THE HAWAIIAN S- physicians as therapeutio agents. He refers LANDS.-Dr. Walter R. Brinckerboff, of the to the olaims made for the various cod-liver Harvard Medical School, has received the ap- oil preparations on the market and states that pointment as director of the United States by the addition of expectorants, anodynes and Government Leprosy Research Hospital corrigents a pleasant-tasting elixir, cordial which is established on Molokai, the island or tonic is made which does not contain a on which the lepers are now segregated. trace of cod-liver oil. He advises pbysicians Dr. Brinckerhoff lately sailed and is now in
to devote about half an hour daily to study. charge at Molokai.
ing the Pharmacopeia, a good dispensatory, SUIT FOR CERTIFYING TO GONORRHEA.
or the National Formulary, in order to acThe annual report of the London and Count. quaint themselves with good, reliable and ies Protection Association contains, as usual. accurate formulae and remedies. an account of various actions taken or threatened against physicians, wbich as a rule the
CAUTION. —The season is approaching when association was successful in defending. One
sudden ohanges may endanger the health of case, which was unsuccessfully defended, is
your delicate patients, especially those sufferof particular interest. A physician wrote on
ing from bronohial and pulmonary troubles. a certificate the fact that a member of a sick In addition to giving good advice as to olub was suffering from gonorrbea and gave
proper clothing and the importance of keepthis certificate to the secretary of the olub.
ing the feet dry and warm, prescribe McThe member brought an action for libel and Arthur's syrup of hypophophites for the con. slander. The physician pleaded that the
valescent, and thus forestall any tendency tocommunication was privileged, but the jury wards tuberculosis, and promote a prompt redecided against him and awarded $750 dam. turn to health ages to the plaintiff. The case shows that a pbysician should never give his opinion of MR. GARDNER: "Well, dear, how are the the nature of an ailment to any one but the tomatoes you planted ?". patient without the latter's consent in writ. Mrs. Gardner: "Oh, John! I'ni afraid ing or in such form as to be capable of legal we'll have to buy what we need this year." proof. The solicitors of the association state, Mr. Gardner: "Why, bow's that, Mary?" in commenting on the case, that when a pby. Mrs Gardner: “I recollected today that sician, in the course of his duties has to fill when I did the planting I forgot to open the up a club certificate, and the ailment is on cans!”