Page images
PDF
EPUB

but added to them are the triple phosfates. In other words, the finding of crystals of triple phosfate in the freshly voided or preserved urin is distinctly abnormal, meaning ammoniacal fermentation in the urinary tract, in turn meaning stasis, and in turn meaning mechanical obstruction, usually in the bladder region, as stone, tumor, stricture, enlarged prostate, and so on. Now and then a case occurs where triple phosfate is found, but there are no bacteria and no vile odor. The urea is low, not because it has been broken down, but because of failure of elaboration, its precursors being used for other purposes. Excess of ammonia is brought to the kidney, and this explains the crystals of triple phosfate. These cases must be differentiated closely. Now and then the urin of a baby will contain thousands of these crystals. There may be considerable irritation and cystitis or stone be diagnosed. These are essentially liver

cases.

The finding of coffin-lids of ammoniummagnesium phos fate in a sample decomposing after voiding has no meaning.

Fatty Urins.

Drops of grease in the urinary sediment have, as a rule, no pathologic meaning whatever. They are usually contributed by catheter lubricant or a dab of smegma. They may result from fatty metastases in fracture cases, but, as a rule, the drops are small and few in number. In the tropics they may be traced to filarial parasites, say the texts, and I merely copy this statement, acknowledging my lack of experience. If fat droplets have no significance this cannot be said of fat granules, which are found in many kidney diseases, in the renal cells, freed by their disintegration or secondarily attached to casts. They point to fatty infiltration of the renal cell. Fat drops are identified with narrowed diaphragm, but the granules can be best seen in preparations stained with osmic acid or sudan III. Keep these points in mind, and you will have the significance of lipuria in a nutshell.

As to Spermatozoa.

No article of this kind would be complete without reference to the occurence of seminal elements in the urin. "They do say" (and you can find it in your texts) that they are often found in the urin of the married woman. Perhaps this is true, but in the specimens which I have examined I

have not made this observation a single time. As a rule, I do not find them in the urin of the male. In most cases I have run across them in the urins of organic prostate disease. I have had occasion to classify all cases as normal (spermatozoa extraneous following coitus), semipathologic (neuroses, especially associated with masturbation, and so on), and strictly pathologic, as in oxaluria dolorosa, diabetes, severe typhoid, prostatic disease, and so on.

The semen may give to the urin the peculiar rank odor and the specimen may be turbid with the spermatozoa, but I have rarely seen such cases. I have considered myself fortunate in finding and identifying the few which were present. They are rarely motile by the time the sample reaches the laboratory, and are easily overlooked. The next article will treat of the urin and bacteria. B. G. R. WILLIAMS, M.D. Director Wabash Valley Medical Laboratory, Author of "Laboratory Methods for the Practitioner," etc.

Paris, Ill.

Office Treatment by General Practician. EDITOR MEDICAL WORLD:-Could I call back a quarter of a century, I would take up a special work and would learn all there is to be known on the subject-that my opinion might be the end of controversy. But after having been a general practician for over thirty years, I would not be in my proper element should I attempt to specialize. For twenty years I have been preparing myself to do general office work by taking private and post-graduate instructions, and by adding therapeutic helps to my office.

When I commenced practise in the year 1880 every doctor was a gynecologist. We were so besieged for help by reason of the suffering of the gentler sex that from necessity we considered ourselves ready for any emergency, and by reason of our chosen vocation every one of us was looked upon as being an obstetrician. Surgery came in for a part of our ingenuity and skill, and found the greater part of us in the emergency and minor rôle, while some time had to be allotted to general medicin, which caused many of us to burn the midnight oil.

With this little preliminary setting, I wish to report a few cases and will notice the diversion of a day in office practise. Will make some mention of the pathologic conditions found, together with the therapeutics and technic in handling the same, referring

more especially to accessory plans of treat

ment.

Uterin Cervical Catarrh.

The first case I will notice is of that class of which we are all specialists, uterin cervical catarrh, this being a germ-laden disease and one which occasions dysmenorrhea and sterility as well. The most prominent symptom besides signs of existing inflammation is the tenacious mucous plug hanging out of the external os. Because of it, local application will do little or no good, and how to get rid of it is a puzzle. It can be done by a curettage, but to do this thoroly requires an anesthetic, and to this so many object. Unless thoroly done we may fail to accomplish much, and not only fail, but leave fresh lesions for the ever-present microbe to renew his energies. Not being willing to give this foe of all enervated tissues an advantage, and believing we should give our clientele our very best service with the least degree of exposure and expense to them, I select from my instruments a well-fitting copper electrode, and insert it up to the internal os. The indifferent electrode is a large pad and is placed on the abdomen. With the positive terminal of a galvanic battery I use from 30 to 40 milliampères of current for ten minutes, at which time we find the electrode firmly adherent, but by a little manipulation it can be removed, bringing away with it every vestige of the albuminous plug, and with its removal we will find the cervical canal perfectly denuded down to the Nabothian glands. We have done a curetment complete and without much inconvenience to our patient, and in a highly antiseptic manner. The positive pole is germicidal; besides it deposits oxychlorid of copper deeply within the cervical tissues by the catephoric action. Two or three more treatments may be required, but perfect success will be the final result.

Goiter.

The next case-a young lady consults us about what she considers an unsightly condition of her neck, in which we find the thyroid gland enlarged. In this case we proceed to apply also the galvanic current with the platinum flat electrode, covered with cotton saturated in a solution of allyl-sulphocarbamid, the anode being the active pole, the cathode the indifferent one, placed on some convenient portion of the body, the abdomen preferred. The cataphoric action under from 10 to 18 milliampères for a pe

riod of ten minutes, seances three times per week will soon reduce, and permanently so, the enlarged glands. Thus the goiter intractable under ordinary plans of treatment, yields readily to cataphoresis.

Neoplasm on Face.

The next condition we will notice is in a

patient between the age of 40 and 75 years, of an excrescence of many years' standing, presenting a neoplasm on the face. History treated thru advice of the profession by the let-alone plan. Finally it became irritable and began to enlarge. Wyeth says: "All removed; also the slightest doubt of the neoplasms not positively innocent should be

character of a tumor is entitled to the inter

pretation of malignancy, the justification of this conclusion being in the well-established fact that an innocent neoplasm may become malignant."

In the removal of this tumor we again make use of the positive pole of a galvanic thru the mass, the indifferent pad being on battery, by inserting a needle under and the abdomen, turn on from 12 to 20 milliampères until you can see the line of demarkation and disintegration of the tissues. Continue this process until you have completely undermined the growth. In fortyeight hours, or less time, it has dried and shriveled down, and is ready to be removed. The positive current, being acid, sedative and a vasoconstrictor, relieves the pain, and, by the cataphoric action on the steel needle, acts as a styptic, also insures against hemorrhage; so we have very little bleeding following this treatment.

At this point, instead of having subjected the patient to the expense of a microscopic test made as to its malignancy, I give him the benefit of the doubt by giving him from 7 to 10 x-ray treatments, keeping the patient under observation for several months, with the full assurance that I have given him the best plan of treatment except surgical removal, to which so many will not submit, and in surgically treated cases it is by far the best and safest plan to follow every such operation with the x-ray treatments.

Neurasthenia

The next patient is a neurasthenic. This is a chronic functional disease of the nervous system, which Beard, of New York, says the basis of which is impoverishment of the nerve force, deficiency of reserve, with liability to quick exhaustion and a necessity for frequent supplies of force. Thus, cerebral

irritation, spinal irritation, neurasthenia, asthenopia, nervous dyspepsia, irritable heart, uterus, ovaries and prostate are but special local manifestations of a general neurasthenic state, and should be studied and treated only in their relation to each other, and to the general condition of which they are only manifestations. Indigestion, insomnia, depression and physical disability are the first symptoms observed by the patient. The best plan of treatment in my judgment, and in my hands, is the Morton wave, the negative head breeze with static electricity, every other day for several weeks.

Paralysis.

The next patient manifests a slight difficulty in breathing, tired, dizzy, exhausted, has not lost the power of co-ordination, but complains of not being able to feel the floor with her foot. I recognize in this a paralytic condition, hemiplegic in type. By making the electrical test, I am of the opinion the lesion is central. Butler, in his "Diagnostics of Internal Medicin," says: "In paralysis affecting one-half of the body you will find an impingement on the brain, while bilateral paralysis is of spinal origin.'

[ocr errors]

Without going further into pathologic conditions, and not venturing to make a prognostic guess, I will proceed to the technic of the treatment. I place the patient in the chair and apply an electrode to the posterior cervical region, the other one to the motor points on the foot and leg below the knee, turn on the galvano-sinusoidal combined current about 4 to 6 milliampères for ten minutes, then change to the galvanic (constant) current, placing the free electrode pad on the forehead and slowly moving it from temple to temple for five minutes, then change the poles and use for 5 minutes more with about 3 milliampères. She goes away feeling perfectly natural, no tired and exhausted feeling, swimming in the head cleared up, which feeling continues for about four days, when she finds it necessary to repeat the treatment.

I want to say that when, in my judgment, surgical measures are the best thing for my patient, I so advise him, and where the objection is not too strong, I call a surgeon and turn the case over to him for operation, and give the x-ray treatments as soon as the patient can leave his bed when there is manifestation of malignancy.

Springfield, Mo.

I. N. LUNSFORD, M.D.

Comments on September WORLD. Burns and Erysipelas.

EDITOR MEDICAL WORLD:-Dr. Slack's recommendation (page 342) of tincture of iron for burns is probably a good one. Why plication, now that iodin has become so not substitute this for iodin as a local apcostly? Iron is antiseptic, but not caustic; it is astringent, and many believe it to possess peculiar powers in arousing the vitality of parts and of the system generally. Local stimulation may turn the scale. toward life in cases where the tissues are injured but possibly not devitalized completely. In several such conditions I have applied one or other of the nuclein preparations with striking benefit. The late Professor Garretson used as an application for erysipelas, equal parts of tincture of iron, tincture of cinchona, and quinin sulfate; painting over the red surface until the "red no longer showed thru the black." success was surprising.

Urinalysis.

His

[blocks in formation]

anal sphincter was dilated and any accompanying rectal disease cured. I have seen collections of encumbering débris along the nerve dissipated by massage and resolvents like iodin and mercury, and would be slow to believe that 1/200 grain of aconitin could remove such material masses. I have applied a little blister over the sacrosciatic notch and witnessed the quick relief when the congestion subsided and the nerve was relieved of pressure. Da Costa's injection of a small dose of morphin in the same situation has done wonders, too. Here, also, the substitution of aconitin commends itself as not being a habit drug.

Children's Diarrhea.

Dr. Wilson's treatment of children's diar

rhea (page 349) has little one would wish to subtract, but there are some important additions that might be made. To an Irish physician, Dr. Harkin, we owe the recognition in the cholera symptom-group of intense irritation of the abdominal branches of the vagus, and the application of atropin as a direct sedative. There is something peculiar about atropin in that whenever it is applied to counteract poisons, like muscarin, or symptoms like these, the remedy is far more potent than its antagonists. Inject hypodermically 1/1500 grain of atropin, and the vomiting and purging are controlled powerfully. Opiates are less effective and more dangerous, as under such conditions narcotism is quickly and fatally developed. More stress might be laid on the radical alterations of diet by which the bacteria are starved out. A week on starches may be thus followed by another of fruit juices, a third of albuminous broths, and then back to a form of milk.

Circumcision and Dilation.

Dr. Feige (page 351) enumerates many affections which he attributes to the irritation of a glans embraced by a tight or adherent prepuce, and he is right in so far

as that this condition does cause such maladies. But there are two fallacies in his argument-implied, but not expressed that these affections are always due to this cause or that it always gives rise to such phenomena; and that circumcision is the only remedy. Take a pair of dressing forceps with crossed handles which expand when compressed; insert this behind the prepuce to the corona and dilate so forcibly that the mucous membrane may be ruptured, then retract and cleanse. Repeat the latter daily

until the tear has healed, and enjoin daily retraction and cleansing as a routine. If the membrane has torn it will contract on healing and shorten the prepuce nicely. This leaves the foreskin to cover the delicately sensitive glans and protect it from friction. Contraction of the meatus, not infrequent after circumcision, does not follow dilation.

"Imaginary Discoveries."

Agreeing with every word the editor has said (page 354), there is still an aspect of the case not touched. Surely we owe to the medical profession so very much that all any one of us can add to the sum total of the professional stock is too little to repay it. But do we owe this to the manufac

turing chemists? They are not in the medical profession; yet it is they who principally profit by our discoveries. Had I my work still to do I should seriously consider taking patents on my contributions and placing them in a trust, the proceeds to be utilized as a fund for the support of superannuated doctors. Then I might be able to so control the manufacture as to prevent the spoiling of my formulas by alterations and substitution of cheap materials.

Impotence.

Here is a case:

A man over 50, the picture of health, correct in habits and apparently likely to live until 80, comes to me with a story of failing sexual powers. He has a natural appetite, but erections fail him. The organs seem healthy and secretion is normal. He has never been excessive and has had no disease of the urogenitals. Let alone, he might be satisfied to leave matters as they are, but a lovely wife demands the fair and reasonable attention to which she is entitled. My diagnosis was dilatation of the superficial penile veins, by which they emptied the organ of blood as fast as the artery pumped it in. I gave the man a little rubber ring, telling him to pass it about the root of the penis when erection commenced. This constricted the veins and held the blood in

the penis until the orgasm was concluded. The patient reported complete success. He seemed to have dropt ten or more years from his age when he next called.

This condition is not uncommon, and many a man thinks he is hopelessly impotent when all he needs is the little ring. What folly to administer aphrodisiacs in such cases! cases! For my part I doubt if there be a condition in which such drugs are really indicated. If desire and secretion are normal, why stimulate them? How can a man be held impotent when these functions are active?

Hyperchlorhydria.

A full dose of atropin, gr. 1/100, stops the excessive secretion of acid more quickly than any other known remedy. The cure rests with diet-teach the patient how to eat correctly. Scotch scones are excellent. Catarrh.

I would drop from Dr. Matthew's prescription everything except the hydrastis. Give this internally, and add a full dose of saline every morning. The late Prof. Hugh Blake Williams said that the secret of curing these chronic nasal catarrhs lay in curing the fecal autotoxemia.

So with Stewart's formula for a wash for pyorrhea-drop all but the ipecac and give it a chance to show its powers.

Subacute Inflammation of Prostate.

An old friend of the great WORLD "family" asks me to write this month something about subacute inflammation and congestion of the prostate gland. Three phases of the trouble occur to me as I write-I am not disposed to prepare a formal treatise on the topic, as you can all find these in your textbooks; so I shall simply give what personal experience has come to me.

Sometimes we have to deal with the results of an old gonorrhea; in which case we usually have cystitis coincident. These ancient gonorrheas used to baffle me until I learned to use arbutin, giving a grain three to seven times a day and persisting for a year if necessary. Many of our best remedies act very slowly, influencing the diseased tissues toward a healthy condition, but not violently or swiftly. The practician who is in a hurry never gets much from such drugs.

Then we have cases where there is also hyperesthesia of the prostatic urethra, as developed by the sound. There may be sexual debility and hypochondria, or not. Here I have had unfailing success with europhen, a dram to an ounce of pure fluid petrolatum. Thymol iodid and vegetable oils have not given me success. I inject a few drops into the prostatic urethra, using a hard rubber uterine syringe, and repeat this every one to three days. I do not say that this will cure every case, but it has not failed in any that came to me.

Sometimes we get a case that exhibits local debility, coincident with the hyperesthesia. At any rate, be the pathology what it may, they get well when we add a few instillations of 1% silver solutions into

the prostatic urethra. These must not be made with the same syringe or near the same time as the europhen applications. I do not like to recommend the latter, because the price is excessive; but I have not found anything else that would do the work as well. The cases that responded best to the silver were all those in which there had been sexual excess in former years. WILLIAM F. WAUGH, M.D.

Muskegon, Mich.

Some Thoughts Regarding Epilepsy. EDITOR MEDICAL WORLD:-I wish to propound a few pertinent questions on this subject that have occurred to me:

Question 1: Is there a case on record where a castrated person has epilepsy? If not, why not?

Question 2: If epilepsy is caused by an auto-intoxication from the bowel, why is it that we have the convulsions after we have

used the "clean out, clean up, and keep clean" plan to as near perfection as it is possible to attain?

Question 3: Why is it that epileptic seizures seem to be influenced by the moon? Now laugh.

Question 4: Why is it that we have the seizures as a sequel to some infectious disease-such as typhoid fever?

Case 1.-Mr. B. at the age of 12 had typhoid fever and immediately afterward he developed epilepsy, and it followed him to his grave at the age of 55. Died in a convulsion.

Case 2.-Miss M. was a healthy girl to the age of 17 years, when she developed typhoid fever, of which she seemed to recover with the exception of epilepsy. Died in the epileptic colony of Texas at the age of 53. She was never relieved of the convulsions after they developed except when under the influence of the bromids.

The above two cases had no hereditary history. Could some lesion have formed "in the system" from the typhoid to have caused this, or was it a "coincidence"?

Case 3.-Boy to the age of 8 months was very

healthy, when he developed epilepsy that continued for two years, when he fell into a pot of hot lye soap and scalded his arm to near middle upper arm. Immediately after the burn the convulsions ceased and did not recur as long as the arm was sore, nor for eighteen months afterward, at which time they returned in a modified form, but gradually grew worse until now at the age of 16 years he is confirmed epileptic.

Question 5: Was it the "soft lye soap burn," the local application of the boric acid dressing, or the irritation that was caused from the burn that caused the convulsions to cease?

There is a great field for investigation in

« PreviousContinue »