Part Fourth. MEDICAL INTELLIGENCE. FOREIGN. 1.-On the supposed Binoxide of Protein. By BARON LIEBIG. According to Bouchardat, if moist fibrine be immersed in water acidulated with a two-thousandth part of hydrochloric acid, the fibrine speedily becomes gelatinous, and on continuing the action of the dilute hydrochloric acid, a solution is obtained, which is turbid. This turbidity appears to arise from a slight admixture of a fatty substance. That portion of the fibrine which is thus soluble in hydrochloric acid, Bouchardat designates by the term ALBUMINOSE, the insoluble part by that of EPIDERMOSE. Mülder states that this experiment was repeated by Herrn Von Baumhauer. The solution of fibrine in hydrochloric acid Baumhauer precipitated by means of carbonate of ammonia, and treated the precipitate with alcohol. After drying, the precipitate yielded, on analysis, 1. 53.64 6.88 15.88 23.64 2. 55.62 6.73 Mr. Mülder concludes, from these experiments, that "the albuminose is a product of the oxidation of protein, which, no doubt, is formed by the action of the atmospheric oxygen upon the matter formed and dissolved by the hydrochloric acid. It is binoxide of protein-C40H62N10014." We have of late been so overwhelmed with descriptions of substances, which, although greatly differing in their properties, yet, according to their analyses, must be considered as oxides of protein, that I was very desirous of convincing myself, by experiment, of the existence of at least one of them. I have found, that if we are to understand by the designation, binoxide of protein, a substance which contains no sulphur, the substance investigated by Baumhauer cannot belong to such a class of bodies as oxides of protein, since the whole amount of sulphur present in fibrine, exists unaltered in this new substance. In the first place, I observed that the atmosphere and its oxygen have no share in the solution of fibrine in hydrochloric acid. If moist fibrine is allowed to become gelatinous in dilute hydrochloric acid, and the mixture copiously diluted with water, and immediately afterwards filtered, before the solution has taken place, the presence of lime and potass may be detected in the filtered fluid. If the fluid be exposed to the protracted action of a higher degree of heat, so as to effect the solution, and a portion of this heated to boiling, with an excess of potass, the subsequent neutralization with acetic acid gives rise to a copious evolution of sulphuretted hydrogen, and a drop of acetate of lead produces in it a black precipitate. Upon solution of fibrine in dilute hydrochloric acid of the above given strength, therefore, the sulphur remains combined with the other elements of the fibrine. If this solution of fibrine in hydrochloric acid (the albuminose of Bouchardat) is mixed with a solution of common salt, sulphate of soda, or nitrate of potass, the mixture coagulates, forming a caseous or albuminous mass, which may be washed with a solution of common salt, the fluid which runs off, containing common salt, contains no longer any perceptible traces of lime or phosphoric acid: these two substances are, however, contained in the precipitate. The fluid contains no oxygen compound of sulphur, and gives no re-action of sulphuret of potassium when boiled with potass ley. But, according to Mulder, the albuminose of Bouchardat is binoxide of protein; were it so, the precipitate ought to contain neither phosphate of lime nor sulphur; but on dissolving it in potass ley, and boiling, and adding, subsequently, salts of lead, a black precipitate of sulphuret of lead is produced, and the action of acid produces an evolution of sulphuretted hydrogen. This substance is, therefore, not a binoxide of protein.-London Lancet. 2.-M. Bricheteau on the Antagonism of Ague, and of Pulmonary Consump tion. This question has been much discussed of late by French medical practitioners, as our readers are well aware. M. Bricheteau, physician to the "Hôpital Necker," analyzes the various communications that have appeared on the subject, including documents from different parts of Algeria, from Bourdeaux, Strasbourg, Lyons, the department of the Ain, Rochefort, Rome, &c.,-ali localities in which intermittent fever is rife,-and appears to come to the conclusion that there cannot be said to be antagonism between the two discasesthat is, exclusion of the one by the other; although the circumstances which favor the development of intermittents may be, and in all probability are, unfavorable to the development of phthisis. M. Bricheteau thus concludes his remarks: "Although, on examining the etiology of these diseases, we do not find incompatibility between the causes of phthisis and intermittent fevers, it is impossible not to recognise, either in the climate of marshy districts, or in the influence of marshy miasmata over the economy, conditions favorable to tubercular patients. Our knowledge of this fact is to be referred to the authors of the labours which we have enumerated. But instead of calling to our assistance some obscure antagonizing tendencies, would it not be possible to account for this kind of prophylaxy, by attributing it to the moist uniform heat which reigns in some marshy districts, and which, by favoring the development of fever, may impede that of pulmonary tuberculization. Does not this appear proved by what takes place at Strasbourg, where the climate being both damp and cold, the town is ravaged by intermittent fever and by phthisis; whereas the more southern departments of L'Ain, La Niévra, Le Var, &c., are decimated by intermittent fevers, but offer very few phthisical patients? We may also add, that it is impossible to deny that in all countries intermittent fevers preserve from other affections. The Dutch appear to be aware of this fact, as Boerhaave informs us, that they are in the habit of congratulating themselves on the return of their fevers. The same Boerhaave, along with Hoffmann, Lancisi, and Sydenham, thought that intermittent fevers freed us from various diseases, and even predisposed to longevity: 'Febres intermittentes, nisi malignæ, ad longevitatem disponunt, et depurant ab inveteratis malis.' Some recent writers think that typhus fever is rarely met with in countries ravaged by endemic intermittents."-London Lancet. 3. Remarks on Scrofulous Degeneration of the Kidneys. By Professor SCHOENLEIN. The symptoms in the early stage of the disease have often a great resemblance or analogy, in the mode of their development, to those which usually indicate the existence of tubercles in the lungs. The constitution exhibits the marks of a scrofulous temperament, and the patient-not unfrequently a boy or girl of from seven to ten years of age-is always more or less ailing, especially after exposure to cold or any irregularity of diet. Complaint is made of an uneasy feeling in the loins; and, when a more particular inquiry is made, it is discovered that the uneasiness is felt, not in the course of the spine, but rather on one side of it. There are frequent calls to pass the urine, especially when the weather is cold and chilly. This frequent desire is often greatest during the night (just as we observe to be the case with the cough in tubercles of the lungs), and the child may therefore be apt to wet his bed during sleep. The urine at first has been observed to be pale and clear, or partially opaque and troubled, from an admixture of mucus; this comes from the bladder; and it is well known that, in the early stage of pulmonary phthisis, the sputa are at first from the trachea. As the disease advances, a more decided pain is experienced in the renal region, and then the urine may exhibit marks of an admixture of blood with it; here, again, we have an analogy to the hæmoptysis so frequent in the second stage of pulmonary tubercle. If the patient be arrived at the age of puberty, there will perhaps be erections, and crampy pains in the scrotum at the same time. Hitherto, the renal affection may be amenable to medical treatment. With respect to the treatment, local bloodletting, the ioduret of potassium, or mercury (rubbed in upon the loins), the use of salt baths, and of a mild unirritating diet,-these are the principal means to be employed. When the disease is further advanced, we can only relieve symptoms. Med. Chir. Rev., from Schoenlein's Clinical Lectures. 4.-State of the Urinary Organs in Scarlatina. By M. SCHOENLEIN. There is a peculiar phenomenon that occurs in the convalescent stage of this exanthem, which is interesting and worthy of notice in many points of view. That there is an exfoliation of the mucous membrane of the mouth and fauces, is known to every medical man; but few are aware that a similar process not unfrequently takes place along the whole course of the urinary organs. That such is the case, may be discovered by examining the urine with the microscope. If this be done, we shall often find a large number of epithelial scales, which, to the unassisted eye, look, in the mass, like a mucous sediment or opalescent muddiness. Schoenlein is of opinion that this exfoliation of the mucous membrane of the uropoietic organs, is the real cause that predisposes the pa-. tient to that form of dropsy which is so apt to occur after scarlatina, and in which the urine is well known frequently to contain a number of blood-globules, as well as a quantity of albumen. Such a condition of the urinary secretion may very reasonably be regarded as indicating a state of high irritation of the mucous surface along which it flows. It is, therefore, a very natural and obvious deduction, that a patient should never be pronounced quite convalescent by his physician until not only the cutaneous desquamation has entirely ceased, but the urinary secretion also has resumed its healthy condition in every respect. If this rule were more uniformly followed in practice, many of the most unpleasant sequela of scarlatina might unquestionably be avoided. The patient should be strictly guarded from cold, and the state of the urine be sedulously watched for several weeks after the decline of the eruption.—Med. Chir. Review; notice of Schoenlein's Clinical Lectures. 5.-The Causes of Albuminuria Illustrated by Experiments. M. Fourcault, being of opinion that albuminuria was a morbid result of suppression of the cutaneous function, instituted an examination of the urine of those animals whose surface he varnished or coated. He found that when dogs so treated began to exhibit symptoms of suffering and difficulty of breathing, the urine first became albuminous; the albumen being often mixed with blood-globules. Very generally, when the animal succeeded in removing the substance with which it was coated, the albuminuria ceased, and the urinary salts re-appeared in large quantities. A shaved rabbit was coated with dextrine, and so inclosed in an apparatus that the urine could be collected unmixed with fæces. A considerable quantity of albumen appeared in the urine. In another rabbit so treated, the pericardium was found to contain an albuminous fluid. The urine of dogs thus coated, previously acid, became gradually less acid, then neutral; and when it contained a large quantity of albumen, a tendency to alkalinity. M. Fourcault flayed Guinea-pigs and rabbits alive, replacing the skin in its proper position, and he was astonished to find that they lived two or three times longer than if they had been encased in an impermeable coating. They maintained their natural temperature, and were lively and vigorous to within a few hours of their death! If, however, a layer of dextrine was laid over the flayed surface, albumen appeared. From these and other facts, M. Fourcault infers that the skin is solely an excreting organ. Its function is to throw off the free lactic acid and lactates already present in the blood. If this acid be retained, it is in excess, and, destroying the equilibrium of the organic affinities, precipitates albumen upon the urinary organs, when the soda of the urine renders it soluble. The cutaneous salts being also thrown back into the circulation, pass off by the kidneys, and render the urine alkaline. According to the preceding hypothesis, the introduction of lactic acid into the circulation would be followed by albuminuria, and M. Fourcault details some experiments which, in his opinion, prove the fact decisively. These experiments do not, however, appear to be of more than questionable value. The same remark applies to the comparison of the phenomena of the cholera Asiatica with those of suppressed cutaneous excretion.-Brit. and For. Med. Rev. 6.-Case of Excessive Secretion of the Ammonio-magresian Phosphate by the Kidneys, with long-continued Vomiting. By GOLDING BIRD, A.M., M.D., F.R. S., Fellow of the Royal College of Physicians, and Assistant-Physician_to Guy's Hospital. Royal Medical and Chirurgical Society, March 24, 1846: Dr. CHAMBERS, F.R.S., K.C.H., President, in the Chair. This case was brought forward by the author in confirmation of the value of irritability of the stomach as a diagnostic sign of calculous affection of the kidney. A lad, æt. 18, was admitted into Guy's Hospital, under Dr. Golding Bird's care, with all the symptoms of scirrhous pylorus, with the exception of non-existence of epigastric tumor. He had for four years been subject to constant irritability of stomach, and had never for 24 hours consecutively ceased from vomiting, never having retained a meal during the period alluded to, for more than an hour, often only for a few minutes. He was emaciated to a skeleton, and appeared actually sinking from exhaustion. There appeared (unless the vomiting were regarded as such) to be no demonstrable evidence of organic disease; the urine had a fœtid, fish-like odour, was copious, limpid, rarely whey-like, of moderate specific gravity, and deposited crystals of triple phosphates in abundance. No hippuric acid or other abnormal element. The urine was alkaline on secretion, and always contained a large excess of the crystals alluded to. Treatment directed specially to the gastric symptoms, having failed to relieve in able hands, Dr. G. Bird prescribed strychnine in doses of gr. 1-16. The result was the gradual diminution of the gastric irritability, the restoration of the acidity of the urine, and the disappearance of the phosphatic crystal. After a few weeks' continuance of the medicine the lad became convalescent, and actually fat. The author entered then into the question of the etiology of the disease, and expressed an opinion of its connection with functional de rangement of the spinal and ganglionic nerves. In conclusion, he pressed upon the notice of the meeting the value of strychnine as an anti-emetic remedy. Mr. Lloyd was of opinion, with Dr. Bird, that the secretion of phosphatic urine, in cases of disease of the spinal marrow, was by no means uncommon; indeed, it was a sign for which he generally looked in those cases, but this state of urine was not, in his experience, at all associated with loss of flesh, or with stomach disease, as noticed by Dr. Bird. He had frequently met with these cases, and he mentioned one in particular which had existed for several years, the chief symptom being pain in the lower part of the spinal region; the disease was considered to be dependent on repeated attacks of lumbago. The urine, however, eventually became phosphatic, and the true nature of the case revealed. He was in the habit, in all such cases, of examining the urine by the aid of the microscope, and had always found phosphatic crystals present. He was not aware whether Dr. Bird, in his paper, had alluded to any other morbid products which were found in cases of this description; but he, Mr. Lloyd, had generally detected much mucus, or a great number of pus corpuscles, in phosphatic urine generally. He mentioned one case in which the urine was loaded with phosphates, and contained a great number of epithelial cells and other morbid products. He had never met with a similar example. In this case, also, the stomach did not sympathize with the morbid condition of the spine; the patient was still under treatment, but progressing towards a state of convalescence. Dr. Golding Bird could not help thinking that two very distinct classes of cases had been confounded by Mr. Lloyd, both of which were characterized by the presence of phosphates in the urine, but the circumstances of each class of cases were widely different. One of these classes of cases, occurring fre quently to the surgeon, consisted of those in which a diseased secretion was poured out from the mucous membrane of the bladder, as the result of chronic inflammation of that organ, stricture, enlargement of the prostate, or where, after mechanical injury to the spine, a more or less complete paraplegic condition had been induced. In these cases, the alkaline and phosphatic state of the urine was produced from changes taking place in the fluid after it had reached the bladder. The urine in these cases was always ropy, and also frequently fætid. If, in these cases, however, the bladder were carefully washed out, and the urine secreted during the next few minutes were examined, it would be usually found to be acid. The second class of cases were altogether of a different nature from these, which, from their dependence on mechanical lesion, were strictly surgical. In the second class, from some antecedent cause, very likely having relation to the function of the spinal nerves, a low form of inflammation or irritation was set up in the kidneys, and the consequence was, a secretion of alkaline urine, which urine contained an excess of phosphates. Dr. Bird believed that the mechanical irritation of the tubular structure of the kidneys by the phosphatic crystals, was the immediate exciting cause of the irritation of the stomach, or of the vomiting. Dr. Taylor thought that the distinction to which Dr. Golding Bird had just referred was an important one,-viz., that between urine which was secreted in an alkaline condition, and urine which had become alkaline only in consequence of chemical changes taking place in it after its secretion. This distinction had been first drawn, or, at least, had been especially insisted on, by Rayer, who considered that urine, which is secreted alkaline, is an important symptom of simple chronic nephritis. Dr. Taylor had had the opportunity of satisfying himself of the fact that the urine is in some cases alkaline when secreted, having made the experiment, referred to by Dr. Bird, of washing out the bladder with water, and collecting the urine in a very short time afterwards. In more than one of these cases he had also had the opportunity of ascertaining, after death, that the kidneys were inflamed, and there was no other appearance to account for the alkaline urine. Whether this class of cases, however, |