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the kidney or kidney pelvis, the reaction is 9. The presence of many pavement cells invariably acid._This is especially true in along with the pus should lead the microrenal phthisis. The acidity is not, as a rule, scopist to suspect vaginal or urethral cona normal and moderate mineral acidity, but tamination, and inquiry should be made as is excessive, and there are present organic to whether or not the specimen was taken acids.
by catheter. Nowadays some nurses know 5. Upon the other hand, an alkalin pyuria, more than doctors, and in more than one and especially a volatile alkalinity, points case I have examined specimens where the rather conclusively to cystitis. Here arises physician supposed that the catheter had the question of combined renal and vesical been passed, having ordered it done, but infection, and it is sometimes difficult to some other person decided that it was not solve where symptoms are puzzling. The necessary. following rules are of some value, however: 10. In males the first urin is usually con
(a.) Where there are vesical symptoms taminated with urethral cells and should aland the urin is intensely acid, it is probable ways be rejected. The finding of the gonothat the disease is primary in the kidney or coccus raises a question, for gonococcus inrenal pelvis and that the bladder mucosa is fection of the bladder is rare. merely scalded, thus explaining the symp- 11. In case the nuclear figures are puztoms. This holds especially in renal tuber- zling, do not forget to add a drop of acetic culosis and to some extent in colipyelitis. acid to the sediment, to bring out the sharp Cure of the renal condition will result in outlines. disappearance of bladder symptoms as a 12. Where there are but few or no pus rule. I am inclined to regard the bladder cells and it is desired to stain for specific as the “urinary stomach” in some of these bacteria, it may be necessary to use a fixadiagnostic questions. The surgeon has tive to hold the sediment to the glass. The learned in cases of stomach symptoms to best fixative is 9 parts of steril and distilled look first to the appendix, gall bladder and water, 1 part of egg white, and chloroform duodenum. And in the same way in "acid to saturation. Use equal parts of fixative cystitis” we had best look first to the kidney and sediment. Smear, fix by heat and stain. and renal pelvis before venturing a bladder 13. The finding of large numbers of renal diagnosis.
cells, ureteral cells, bladder cells or prostate (6.) Casts, renal cells or kidney symptoms cells in cases of pyuria have some weight in should lead us to suspect combined disease locating the lesion. Other factors are more where the urin is alkalin (ascending infec- important, however. tion), and here a cure of the kidney condi- 14. Urinary mucus is not pathologic; pus tion is not likely to relieve the bladder con- is. When the urin is ammoniacal, the pus dition. In combined disease, the reaction
may become ropy like mucus. Unfortuof the urin is of great prognostic import- nately the term, muco-pus has been applied ance.
to this sediment. The term “alkalin pus” 6. Do not rely on chemical tests for pus, is much better, for there is no actual increase but resort to microscopy in every case. in mucus. The best chemical test is that of Donne.
Renal Tuberculosis. To the sediment, add a bit of caustic soda, and stir with a glass rod. If mucus, it will I have referred to tuberculosis of the kidbecome thin and flaky, while pus will be- ney in several of the above considerations, come gelatinous, thick and tough.
and will merely list briefly some of the main 7. Polymorphonuclear cells argue for in- points. Since we have learned so much confection by the colon bacillus, pyococcus or cerning colipyelitis and other urinary insemipathogenic bacteria. They may be fections, we have come to realize that renal present in late tuberculosis after secondary tuberculosis is, after all, not a very common invaders have complicated.
condition, and has been diagnosed too fre8. Lymphocytes, endothelial leucocytes or quently in the past. other mononuclear cells, appearing in the 1. A case which recovers without surgical majority, argue for pure tuberculous in- operation is probably not a case of tuberfection. Do not mistake renal cells for culosis. mononuclear pus cells. (See preceding ar- 2. Renal tuberculosis is not a common ticle, in October World, on urinary mi- disease. croscopy.)
3. Renal tuberculosis is rarely primary. Lesions may usually be found elsewhere- 3. Females are especially prone, but males glands, lungs, spinal column, adrenal or
do not escape. Fallopian tubes.
4. The symptoms may be vesical, but the 4. In renal tuberculosis there is usually high acidity, if present, will suggest scalda loss of flesh. In colipyelitis there may be ing: a loss of flesh, but usually the patient grows 5. History of cutaneous abscesses may fat if given the rest treatment.
precede the attack. 5. Early chills are suggestive of colipy
6. The urin rarely has a fecal odor. Do elitis rather than tuberculosis.
not expect it. 6. It has been claimed that tuberculosis
7. Chills are likely to occur at the onset. may complicate pyelitis. This may be true,
8. A hanging drop may show thousands but in a large number of cases I have not
of stubby bacilli, some feebly motile. Pus made this observation except perhaps in a
may be absent at times. single one, and this was doubtful.
9. The inoculations on special media fur
nish final proof. 7. If the patient is a female between the ages of zero and 45, think of colipyelitis be
Other Infections. fore renal tuberculosis. 8. Colon bacilli are not always easily de
Sometimes typhoid bacilli appear to cause colored by acids, and the morphology of the
a pyelitis, but usually the pyelitis following rods as well as the staining characteristics
and complicating typhoid fever is caused by
In some cases a gonormust be kept in mind. The smegma bacil- the colon bacillus. lus may mislead.
rheal infection may ascend from the urethra 9. The pus is usually mononuclear, es
and involve the bladder. A gonorrheal cyspecially in the early cases.
titis is usually serious. I have never known 10. The reaction of the urin is usually in
of a fatal case, but the agony is intense. tensely acid, but intense acidity is noted in Speaking of urethral infections, I have seen
several that were not due to gonococci but many cases of colipyelitis. 11. The urin when examined by the hang
to other cocci. Primary staphylococcus in
fection of the kidney may occur, but it is ing drop method is apparently steril.
rare. The staphylococcus may play the part 12. Now and then the typical beaded acid- of secondary invader in tuberculosis of the fast bacilli may be found in smears.
kidney. Remember what was said concern13. Some cases may be manifestly sur- ing the tendency of cocci to be found in algical, and interference may be necessary be- most every sample of urin, and that it is fore the laboratory man can make a final
not always easy to accord to them a vicious diagnosis. Be careful here.
rôle. cases have been diagnosed and operated without laboratory data. Many a kidney
Semipathogenic Urinary Bacteria. doomed to a surgical grave has contained The most important of these is the promany stubby bacilli and not a single slender teus vulgaris, but there are many other miacid-proof rod.
cro-organisms which fall into this class. 14. The laboratory man's trump card is When for any reason there is urinary stasis, the cavy inoculation. This may be done es- as in enlarged prostate, calculus, tumor or pecially in those cases where the urin is ap- stricture, these saprogenic bacteria get a parently steril. Do not expect the pig to foothold and cause ammoniacal fermentalive long enough to develop tuberculous tion of the urin. Pus cells receive the word peritonitis or adenitis if the sample is that the normal bactericidal properties of the swarming with colon bacilli or pyococci. mucosa have been broken down, and rush
to reinforce. The condition is not a true Colipyelitis.
infection, but urinary antiseptics are indi1. Colipyelitis is probably the most com- cated. The main problem for the physician mon infectious disease of the kidney. It is is that of removing the mechanical obstrucroutinely diagnosed clinically by some men tion causing the stasis. as tuberculous kidney, and skilfully removed Other fermentations, but of an acid nawithout laboratory examinations.
ture, must be held to account for renal cal2. Some cases of colipyelitis are surgical; culus. In fact, the clinical oxalurias are most cases may be cured by rest and urinary doubtless due to unknown types of bacterial antiseptics.
action rather than metabolic in origin.
The next article will treat of "Tissue habitually sacrifices himself to his duties. Examinations Worth While.”
But on one point I am emphatic—that the Paris, Ill. B. G. R. WILLIAMS, M.D. chief obstacle I have encountered in trying Director Wabash Valley Medical Laboratory, to cure these patients is the perfect ease with
Author of "Laboratory Methods for the
which they can secure supplies from drug
gists without prescriptions or any other Comments on October WORLD.
authority. But this refers to pre-Harrison Editor Medical World:—The enjoy- law times. Now it is different, and the able thing to me about these chats with druggists seem to have reformed. Moreyour big "family” is that one may sit down over, some recent experiences have shown and talk, without going to the trouble of
that with this danger removed the cure is hunting out of the library all the recent
easier and there is less suffering than ever work done on any topic, and giving a lot of before. My last case required during the textbookish material that anyone of us may
day a combination of physostigmin with get if he thinks enough of the matter to do spartein; by night gelseminin, cicutin and the digging. We just give here our expe
cactus; with persistent mild catharsis, and riences and opinions, and anybody is at lib
careful feeding. Prolonged hot baths are erty to accept, deny. try, prove or disprove, very grateful and save many an hour of disat will and opportunity. There is a wealth
comfort. But, . above all, rest is essential. of information among the medical men that
The man may feel fine and fit, ready to work would be invaluable if one could get it out;
and impatient to get at it; but let him take but we are so blamed particular, so afraid
a light ax or a bucksaw, and in five minutes of committing some blunder, that we keep he is all in. Then come the aches in the silent when we ought to talk and give the leg muscles to show him how fragile is his rest a chance at our ideas. Lots of times strength, and that his endurance is nil. The some World reader has written to me,
moment fatigue or annoyance touch him, sometimes corroborating a statement and
the old habit of taking refuge behind the · sometimes showing me wherein I
drug comes uppermost.
This must be wrong. The net result is that I have
unlearned before we can talk of a cure. learned a lot and given some in return.
“Wealthy Heights Estate." Wow ! ! ! How quickly they picked me up once when I inadvertently spoke of using
Well, I have a few lots on Long Island, atropin in glaucoma!! Of course I knew
for which I paid a strictly nominal pricebetter, and should not have been so care
a few dollars. I was careful to write for a less; but I said it all the same.
bill of the taxes next year, and the reply THE WORLD reminds me of the anteroom
was that the property was not worth taxof the lodge. We get out there, light up,
ing. Considering the rule that non-residents remove our heavy regalia and coats, and the
are always in open season to the tax colshirt-sleeve talk there determines what shall lectors and assessors, I concluded the lots be done in the lodge.
must be mighty bad. Narcotic Habitués.
Taking Care of the Kidneys. My quarter-century of treating drug One sentence in Williams' article (page habitués does not permit me to give much 379) arrests my attention—“Man numbers testimony as to the responsibility for these his life and health in hours by his normal habits. Of about 700 cases coming to me, renal cells." We all know how quickly by far the largest number were physicians. death supervenes when the renal cells quit Of these, nearly all fell victims to the se- work; and we also know that when the ductive drugs in the effort to fulfil the du- solids of the urine fall far and continuously ties of the profession when physically un- below the normal output, the patient is fitted by illness or fatigue. I have long being poisoned as rapidly as the collateral since learned to look on a physician-habitué elimination permits. But do we think of as a victim to professional devotion until an- the hygiene of the renal cells, and the presother reason for the habit has been shown. ervation of these most essential structures ? Overwork, too much responsibility, and the I think there is no sanitary law most freknowledge that a “shot” will carry one thru quently and generally ignored than that and develop the best that is in him—there is which forbids the stimulation of organs that the temptation placed before a man who need no stimulation. In no tissue of the
body are the consequences more disastrous and get a magical relief. I think the same than with the renal parenchyma. Every reasoning applies to Dr. Buck's method of drop of alcohol, every atom of volatile oil blistering (page 392) for pleurisy and pneuthat we take, in relishes, pepper, mustard, monia— lessening the hyperemia relieves the horse-radish, and spices of all kinds, inflict painful pressure on the sensory nerves. But on the excessively delicate renal cells an ir- I suppose that nowadays they will tell us ritation that in time, multiplied several times that an autoserum is this product that being daily, induce atrophy of the cells and hyper- reabsorbed antagonizes the disease-inducers. plasia of the connective framework - How is it? The benefits from reabsorption organic atrophy in fact.
of the serum from blisters was noted when
they were employed as cure for syphilis by Epilepsy.
a Norwegian savant, many years ago. Dr. Meek (page 387) can ask more ques- The method was condemned, as there was tions in a minute than any one man can an- no distinction made between syphilis and swer in a week. As to epilepsy in castrates, chancroid, but the benefits from the blisters he should apply to the profession where were recognized and occasioned some comeunuchs are more common than here. I do ment. Strong aqua ammonia causes a blisnot now recall that I have even met one in ter very quickly, and without the inflamAmerica. (2.) Epileptic convulsions fre- matory reaction following cantharides. Fill quently persist after the original exciting a thimble loosely with absorbent cotton, wet cause has been removed. Push a rock down it with ammonia, invert over the skin, and hill and it keeps moving after the foot in a minute remove and the blister will be pressure has ceased.
(3.) Every asylum formed. can tell that when the moonlight is bright
Old Age. there is far more noise and wakefulness at I have suffered from advancing years night than in the dark weeks. (4.) Typhoid lately-does any brother know of a remedy? leaves the body loaded with toxins in addi
WILLIAM F. WAUGH, M.D. tion to those normally produced; and it also leaves an impressible nervous system. (5.)
Germs and Their Relationship to Disease.
No. 1. matter—but what do internes know, anyhow! Dr. Mann replies to one question,
EDITOR MEDICAL WORLD:-All organic with an important case of recovery after
forms originate in cells, germs or spores. removal of adenoids.
The human body is composed of a multi
tude of cells; the individual cell is the morCircumcision.
phologic unit of the tissues and body of man. My criticism of the circumcision discus- The earth, and water, are the habitations of sion is that one and all state their opinions, myriads of germs and matured forms; some but do not cite facts and statistics on which of which are pathogenic to the human body. we may make our own decision. Besides, In their life history germs are influenced if you wish to get at the truth of a matter, by their environment and condition, and, do not trust those who only seek to prove hence, to mutations of form and physiologic their own side. Who is there who does not activity. Tissues of the human body are care a.doit which side wins, but has evidence likewise influenced by environment, condito offer on either ?
tions of life, and chemical and germ inva
sions. Of all the germs found in nature, the Inflammation, Pressure and
great majority are harmless. Those that afAutoserotherapy.
fect the body injuriously are termed pathoSciatica induces an access of blood to the genic. nerve and its sheath, and where this passes The papers which follow have concern thru the sacrosciatic' foramen or notch, the with only a few of the pathogenic germs in increase in the bulk of these structures their connection with certain diseases. causes pinching. This is relieved by any- As stated above, germs are subject to muthing that subdues the hyperemia, as Dr. tations of form and physiologic activity. Dreher (page 392) found when he applied This fact we wish to impress upon the minds his cups over the foramen. I used to apply of our professional brethren in order to neuvery small blisters directly over this locality, tralize the prevailing thought—that a specific disease is the result of an invasion of a (bacillus coli communis) of everybody's alispecific pathogenic organism.
mentary tract. We believe that disease is the departure form and habit, and midway between them are
These two species resemble one another in in special tissues, or of the body as a whole, certain bacterial species which add to the more from the normal in special directions, thus benign characteristics of the typhoid bacillus ; preparing for the invasion and development
these latter being known as paratyphoid bacillus of certain pathogenic germs.
A and paratyphoid bacillus B. Paratyphoid is a
milder disease than typhoid fever, and epidemics These germs in their life history being sometimes occur shortly after epidemics of true subject to mutations of form and physio typhoid. logic activity, may be rendered innocuous;
But still more confusing than the colon bacillus
group is the group of apparently interchanging thus health be restored to the victim of their bacterial types which are concerned in the causainvasion.
tion of throat and nose infections and so-called With regard to mutations of form in bac- rheumatism or joint infections. The streptococteria, Professor Ferdinand has the following factor of tonsillitis and complicating or second
cus has been commonly recognized as a frequent in his work on "The Principles of Bacteri
ary acute rheumatic fever. Also in a large numology," pages 12, 21, 22 respectively: ber of cases, bacteriologically studied, pneumococIt must be remarked, furthermore, that even
cus has been found in pure culture in and about
the inflamed joints of articular rheumatism.
The very fact that some investigators found cording to the nutrient media in which the bac
streptococci, while others found pneumococi in teria are growing. This holds true, indeed, to
such cases, has only made practical physicians such an extent that the prevailing form of a given
skeptical of bacteriologist's results. species may be assigned to one group or another
Recent studies by Dr. Rosenow, and others, according as it has been taken from one or an
have demonstrated beyond question that an actual other medium.
transmutation of pneumococci into streptococci One of the greatest services Koch has rendered
can be brought about under artificial culture. The
transmutation in all likelihood occurs in the huto bacteriology is his invention of pure culture, by means of which such isolated colonies, orig
man body under certain conditions. inating from a single germ, can be cultivated at
Rosenow has taken pneumococci from the lung, will and obtained free from admixture with germs
from the sputum and from the blood of a pneuof other kinds. Such pure cultures, reared under
monia patient, grown them in culture tubes and perfectly similar conditions, always agree in form gradually "educated" them till they became and physiologic activity. But this is not real
streptococci. constancy. The similarity does not depend upon
These transmuted germs, when injected into the invariability of the bacteria, but upon the fact
rabbits, produced joint, heart valve and heart that the conditions of life suffer no alteration.
muscular lesions seen in human beings with acute
Other laboratory workers have accomplished
equally remarkable transmutation. The value, then, of the individual shapes Auc
Mme. Victor Heuri, of the Pasteur Institute in tuates very greatly. At times it is the transitory form, at other times the common nature form that
Paris, began with the anthrax bacillus, a deadly
microbe in animals and human beings, the most is deemed typical. On this account it is super
virulent she could find, submitted cultures to enfluous, at least in the beginning, to determine,
vironmental changes, exposing them briefly to with rule and compass, the regulation breadth
ultraviolet light, for instance, and ultimately proor length of a species, while general morphologic
duced a species of bacilli which failed to show questions remain unsettled. * * *
the pathogenic effect when injected into guinea Bacteria depend for their provision of food
pigs. and energy upon the conditions of nutrition. If
Drs. Thiele and Emberton took bacillus micthese conditions remain constant one of three
cides, a common, non-pathogenic microbe found things comes to pass. Either the bacteria change
in garden soil, grew cultures at low temperature in form and action, and adjust themselves to the
(the germ will not survive at body temperature), new conditions, or they form spores, which pre
gradually increased the temperature with successerve the species until better times for them to re
sive generations and succeeded in educating the turn, or they fail to adapt themselves at all and
germ to grow at a body temperature in the inso perish.
cubator. Dr. Henry Plotz, a fellow-alumnus of the
Animals were then injected with the educated writer, in his biologic studies, has identified the
bacilli, and it was found that the previously harmbacilli found in Brill's disease and typhus fever less bacilli had acquired the characteristics of as being two different strains of the same micro- the deadly anthrax germs. organism.
The same experimenters have taken the smegma We quote additional evidence to support the bacillus, a harmless microbe universally found on preceding statement as to the mutability in form certain parts of the human body, educated it and physiologic activity under varying conditions under artificial environment, and transmuted it of environment.
into a virulent organism which produced tubercles There is a growing suspicion that the typhoid and death in a week or two in animals, the postbacillus is really nothing else than a highly edu- mortem findings being identical with those of cated strain ascending from the colon bacillus tubercle bacillus, which resembles smegma bacil