5 to 10 drops three times a day will give great relief, but is of no use in the second stage. Arsenic will be useful in removing the malarial cachexia, also China, but when the liver is seriously complicated will be of no use. Argentum nit. This is very useful in the grave pathological conditions for the cachexia, emaciation, affection of the liver, dropsy; not of any use until the distinct periodic accessions are stayed. For the genuine cirrhosis Phos, will take the first rank, from its pathological changes. Merc. is useful only in the first stage, but not after the contraction has commenced. Hepar sulph. is frequently called for and will go a long way in the symptomatic treatment of this disease. Hydrocotyle is very useful; it produces interstitial inflammation and cellular proliferation. (L. Salzer, M. I., vol. IV, p. 215, 1876.) Distoma Hepaticum is worthy of careful attention, not because it is a dangerous Bile Pigment. A new plan for detecting. The urine is filtered through ordinary white filtering paper, by means of which the latter is rendered of a yellow or brown tint. If a drop of concentrated nitric acid is allowed to fall upon the inner side of this prepared paper, the spot which it touches becomes yellow, then yellowish red, and, at the edge, of a beautiful violet tint; further out there forms an intensely blue ring, which passes almost immediately into an emerald green. (Ext. in N. E. M. G., vol. XI., p. 288.) Jaundice. Iodine in chronic. (J. O. Moore, H. W., vol. II, p. 369.) Mercury produces in large and poisonous doses a sweiling, a so-called hyperplasia of the liver, increased secretion of bile, and copious perspiration. Mercury is, ther fore, to us a great hepatic remedy; but we will find it only suitable in enlargement of the liver, not by fat, but by an excessive formation of hepatic cells, in excessive secretion of bile, and in profuse sweating. Mercury is not indicated in a nutmeg-liver caused by blood-stasis in consequence of valvular disease of the left heart. Chelidonium diminishes the activity of the hepatic cells in the healthy body, showing itself by gray color of the fæces with slight coloring of the urine, and a total absence of all icteric symptoms. Buchman taught us that Chelidonium cures such a case, just as Bryonia frequently cures morbid states of the peritoneal covering of the liver. Many cases of poisoning with Phosphorus, microscopically studied, have shown degeneration of the cardiac muscle, and Phosphor. will always be an important remedy in fatty degeneration and destruction of the muscular fibres of the heart, but in the simple obesity of the heart, where large quantities of fat lie imbeded around the heart, and between its muscular fibres, but without destroying their structure, Aurum muriaticum is a far better remedy. The microscope shows us that the urine of a patient complaining of severe pains, contains fresh, not decomposed, blood-cells, but no urinary cylinders, and Cantharis is our remedy, but every physician would prefer Hepar sulph., where in a nephritis the microscope reveals to him urinary cylinders in the urine but no blood-cells. (Translated by Lilienthal, H. M., March, 1876.) Biliary Calculi. Extracted through the abdominal walls. (O. M. and S. R., January, 1876, p. 44.) A case of. (J. Bumstead, M. I., vol. III, p. 382, 1876.) Passage of. Bell. 30 has always relieved the pain without the use of ether. Chelid. maj. is a good remedy to remove the disease. E. T. Richardson, M. I., vol. IV, p. 450, 1876.). Chin. 3x is said to prevent the formation of these concretions. (H. Smith, H. W., vol. XI, p. 34.) Gall-stone Colic. Cured by China. (D. Thayer, Mass. Trans., vol. IV, p. 155.) China will radically and permanently cure every case; if it does not relieve in the more severe attacks, ether must be inhaled or opium taken to relieve the severe pain; it will not interfere with the action of the China. (David Thayer, M. I., vol. IV, p. 307, 1876.) Treated with Colocynth and Emete in alternation, China given for the remaining icterus intermescence and the sensitiveness of the region of the liver helped greatly; later, after another attack, the pain in the region of the liver which remained was helped by Mercur.; another case was treated with Colocynth. (Dr. Gerstel, A. H. Z., 92, p. 142.) Leucocythæmia. Aconitum nap.; Arsen.; Carbo. veget.; Sulphur; Carbon. of lime; Phosphate of sod. (T. Cigliano, Riv. Omnip. Roma, vol. XXI, p. 266.) On the contraction of the Spleen and its relation to the liver during stimulation of the splenic nerves. (A. O. 1876, p. 484.) Swelling of the Spleen. It is observed that the swollen spleen decreases under influence of induction current, the decrease continuing either while the current acted or for a whole day. Simultaneously an enlargement of the liver was sometimes observed, caused by a larger quantity of blood being pressed into portal system by the diminution of spleen. (A. O., 1876, p. 405.) KIDNEYS. Kidneys. Ulceration of. (Geo. B. Valum, Trans. N. Y. S., 1876-7, p. 145.) The Movable. Most frequent in women, and right kidney more often affected than left. It may be caused by congestive state in abdominal organs at every menstrual epoch, rarely in consequence of enlarge ment of kidneys caused by nephritis. Young women suffer most with colic, vomiting, palpitation, etc. Women in the climacteric years suffer but little, if any. Young women must have absolute rest at menstrual period. Iodine ointment may be applied to remove venal congestion. (A. O., 1876, p. 412.) Hæmorrhage from the. Ergot 1st. (Dr. Molin, A. H. Z. 92, p. 148.) Diabetes Mellitus. A decrepit man, 52 years of age, complained that he had not had a wink of sleep for a whole week; his most ardent desire was to be able to get a good night's sleep. In answer to the question as to what was the matter with him, he was of opinion that he had the gout in his left leg. It seemed to him as if the bones were sore and the flesh loose; at times there was a burning shooting through the leg, then a general, to him inexplicable, restlessness, and finally a morbid twitching in the leg from below the knee down to the heel, so much so that he would frequently observe these twitchings of the limb for hours. This peculiar attack usually came on by night, but he was constantly haunted with the fear of them; at times this was accompanied with pain, but not always. I gave Aconite in a low dilution, and, becoming better acquainted with my patient, I learned the following from his communications and from my own observations: For about the last three years patient, who otherwise had continued at his business, has been feeling himself out of sorts and unable to keep closely to business. His mode of life could hardly be called regular. His motto is "business before pleasure." The most necessary acts were attended to when he had time. Rest was taken only when his powers began to fail. A restless life at home, varied with fatiguing journeyings, had filled up the last thirty years. But now this is no longer possible, in consequence of frequent indispositions. Two medical men (allopaths) had in vain plied their art before me. They had ordered vapor baths, injections of Morphia, Colchicum with Opium, Chloral hydrate; they had cupped, and rubbed in all sorts of salves. Besides the before-mentioned symptoms of the left leg there is considerable disturbance in the digestive apparatus. The tongue shows a smeary gray coating, its margin indented here and there, red and painful; there is a tendency to circumscribed inflammation of the mucous lining of the oral cavity. Taste insipid; hunger; dislike to flesh meat. Bowels lazy; an insufficient evacuation every three, four, or five days after repeated enemata; micturition irregular; urine thick, muddy, yellow, or very dark or transparent. The urine was examined in a local laboratory in my presence, and found to contain sugar. A quantitative analysis was not undertaken on account of the expense. The specific gravity of the yellow, muddy, thick urine 1036, that of the darker, but transparent, 1038. As soon as the analysis had shown the presence of sugar in the urine I communicated the fact to the patient. I told him plainly that his symptoms were, in my opinion, due to glycosuria. The rather indolent patient, but otherwise, however, a man of certain education, and who knew a good deal about the serious nature of the complaint from hearsay, was neither rendered anxious by my communication, nor did he follow the not unusual and meaningless plan of tall talking and big promises. On the contrary, he seemed quite indifferent, and wanted special attention directed to the violent pains in the lower limb. The drug which has the most symptoms of diabetes mellitus is, perhaps, Lachesis, as American and other physicians have placed it before us. But its exact proving hardly lies within our sphere of observation, and the remarkable effect of the bite of a Dipras has probably not been seen by a single European physician. No doubt several of the metals have a pretty near relationship to diabetes mellitus. We know that sugar is found in the urine of persons suffering from chronic metallic poisoning; in like manner these agents produce a number of other analogous symptoms. To these we must reckon Arsenicum, Pb., Cuprum, and the latterly much-mentioned Uranium. Besides, I have satisfied myself by my own experiments that, after several weeks' ingestion of small doses of Uranium muriaticum or Uranium nitricum by healthy persons, sugar can be found in their urine. Uranium muriaticum, a quarter of a gramme of the second decimal trituration, dissolved in 200 grammes of water, and to be exhibited in four equal parts at convenient times in the day. Although with this attenuation there is no specific taste, still less any disturbing primary action in the stomach, yet it generally happens that between the second and the sixth day of its exhibition the patient experiences disgust at it. Hence, I found myself compelled, also in this instance, to make concessions, and allowed the drug to be omitted on the fourth and fifth day, but thereafter it could be taken again. The diet during treatment was so arranged that flesh meat was recommended, prepared as nicely as possible, and the use of farinacious food was somewhat restricted but not forbidden; light vegetables were allowed, and Faching water to be the drink. The before-mentioned constipation had to be met with emollient enemata. Under this treatment the condition remained, with slight variations, the same up to the middle of the third week. At this period a feeling of euphoria came over the patient, the first time for many a long day. The dread of the before-mentioned attack left him, and he got a healthful uninterrupted night's sleep, followed by a better day, but toward the evening of this day the old ailment returned, but not so badly. The next nights were got over so that up to 11 or 12 an inexplicable dread, and at times pains, seized upon him, then followed sleep, quiet, and increased activity of the skin; gradually an evident amelioration, also during the day, became manifest, and with it confidence in returning health. His looks and his state of nutrition were better; his digestive organs were performing their functions less abnormally; the mucous membrane of the mouth had assumed a fresher appearance; his appetite for flesh meat was good; there were good alvine evacuations about every other day; mental and bodily vigor had returned. The appearance of the urine was pretty well normal, showing, however, off and on, the before-mentioned irregularities, but constantly in a lesser degree. The specific gravity of urine was 1023, as against 1036-38 at the beginning of the treatment. The chemical test still showed the presence of sugar in the urine, but still there was a notable difference in the intensity of the reaction. A lady, moving in the higher walks of life, æt. 63, fell ill in August, 1874, of febris gastrica. My lady was by no means unaccustomed to dyspeptic troubles, and she was herself quite aware that she gave her digestive organs more work to do than they were capable of. She ate much and often, had a choice super-refined kitchen; eating was her way of killing time, and she killed it with a vengeance, remarking often that "eating was her sole pleasure." With this she drank not exactly too much, but still divers glasses of port and sherry, and, furthermore, she had the habit of smoking from ten to twenty cigarettes a day. She took almost no exercise at all. She maintained that for the last five years she was quite unable to walk except on softly-carpeted floors. Within doors she lounged heavily from sofa to chair and then back again; she drove out once or twice a day to take the air or to pay visits, and when it came to getting up a few steps, why, the rich lady had servants to bridge over the difficulty. For years she had been getting corpulent, and her weight varies from 160 to 170 pounds. Fatty degeneration of internal organs, especially of the liver, was shown to be present. Dyspepsia, colic, constipation, diarrhoea, etc. But such "little disagreeables" were not sufficient to deter her originally robust nature from her evil way, and the less so as she soon got the better of them. But the febris gastrica was all the more disagreeable. She could not understand how it was that this attack in August, 1874, should be so stubborn, or why the fever should run so high, when thus far all her gastric disturbances had gone off so easily. Her temperature had gone up to 40° C., and called for the application of cold ablutions. Toward the end of the sickness there was a complaint about a painful spot in the sacral region. I thought of decubitus. Viewing the part, I discovered two little cutaneous furuncles, and a more close inspection revealed a whole lot of little scars about the back, traces of ancient furuncu lar processes. On questioning the patient she said she knew that very well, and likewise knew the cause of the whole trouble; she had been suffering from diabetes mellitus for the past six years. There was no ground whatever for doubting any of these statements, and, The copious sediment consists of epithelial cells and uric acid. This places the diagnosis of the case beyond doubt. Besides, there were, however, the following interesting symptoms, which have already been touched upon, viz: 1. Very dry skin, mealy desquamation, tendency to furuncles. 2. Badly-nourished muscles, especially those of the extremities. 3. Fatty condition of internal organs. 4. Great thirst, which can rarely be slaked. 5. Copious micturition, corresponding, of course, to the quantity of imbibed fluid. 6. Large appetite, feeling of hunger. 7. Dryness of the inner mouth, not infrequently a feeling as if hairs were in it. 8. Notwithstanding good living and tolerably good appearance, constant feeling of weakness, almost complete incapacity of walking. On this basis the treatment was begun. I had made up my mind to give Uranium muriaticum against the diabetes me litus for the following reasons: 1. Because the symptoms produced by it have a great similarity with those present in this case. 2. Because this drug has of late been highly extolled in the treatment of this affection; and 3. Because I have already seen favorable results from its use. Gave my patient at first gramme powders of the second decimal trituration, each powder to be dissolved in water, and to be taken in three doses during each day. But my patient very soon began to take liberties. That is to say, she took such very tiny sips of the medicine that it would have taken her two days to consume the daily dose. To be even with her on this point, I prepared powders of Uran. mur., 2, each containing gramme, and gave strict instructions for her to take one of these three times a day. I was obeyed for nine days, but on the ninth day she had very great dislike to the drug. So I gave at first Ipec., and then Nux up to the sixteenth day. Then a day's pause, and from the seventeenth the Uran. mur. again as before. For four days patient took two powders a day, then for further fourteen days three powders. Thus passed five weeks, and I found it prudent to pause for a couple of days, as she had again become disgusted either with the Uranium or with taking physic. After this two day's pause patient wished to take China Why, I do not know. Perhaps she had once heard that China was good for diabetes mellitus, perhaps it was from some other caprice. o attain my object I gave way and exhibited Nihil., instead of China. So I got back, with these concessions, to Uranium mur. Again, in four days, and before the commencement of the seventh week, patient was again getting Uran. mur. 2, gramme, ter in die. This was carried on for fourteen days, then followed nine days with the same dose twice a day, and then ten days with only one dose a day. With this medication eleven weeks had elapsed since the beginning of the treatment with Uranium, and here I pause to report on a few other points. I have first to speak of the arrangements about diet. My readers will remember that, at the commencement of this report, mention was made of patient's great appetite. If I had been rigorous in this case about the diet, I should soon have lost my patient. Besides, I do not see the object of strictly prohibiting all those articles of diet which, within the human organism, are soon transformed into sugar. It would rather seem to me that such abstinence during the exhibition of a specific remedy is rather calculated to render the results of the treatment inconclusive. The diseased organism should be led by our medicines not to act abnormally. By that strict deprivation we should get an artificial and not a dynamic diminution in the glycogenesis, and the most favorable analysis after such treatment could have no great value. Hence my instructions as to diet were limited to the absolutely necessary. I forbade vinegar and acrid spices; somewhat limited excessive ingestion; and regulated the meals on general principles. Tepid baths of 25-26 Réaumur were ordered twice a week. The condition of the patient during the treatment was, with the exception of slight disturbances, and of the disgust created by the remedy and by the unusual restraint in her mode of life, on the whole good and visibly improving. After a treatment of eleven weeks things stood thus: The action of the skin is better; the skin feels softer, and there have beer no furuncular processes these six weeks, the quantity of urine is diminished, and the quantities voided at different periods of the day no longer show any notable differences. The thirst is more easily quenched. The former feeling of hunger has given way to simply a good appetite. Disturbances in the digestive tract frequent. Dryness of the mouth gone, but there are still abnormal sensations in the mouth. She feels better, and can walk a very little better. At this stage a further urinary analysis by the same authority is made at my request. The result: Sp. gr. 1013; reaction, slightly acid; sugar, unweighable traces; albumen, none; sediment slight, composed of epithelial cells and uric acid. On comparing this analysis with the one made before Uran. mur. was commenced, we find that very great improvement has been made. Dr. B. Bæhr says in his Therapeutics on Homœopathic Principles, art. "Diabetes Mellitus:" "We must maintain that it is a pernicious deceiving of one's self to believe that one has really done any good by an artificial reduction in the production of the sugar. Only when there is a diminution in the quantity of sugar while patient takes his usual food, can we say that the inclination of the organism to faulty elaboration of its material is lessened." Have we in the present case, in which there is a material reduction in the sugar formation, and in which there is at the same time a corresponding and manifest amelioration, both subjectively and objectively, such a deceiving of one's self of which Dr. Bæhr speaks? I think I may safely answer with an emphatic no, and as proof of this I refer to my regulations with regard to patient's diet. I avoided rigorously depriving her of those stuffs which are easily transformed into sugar, and tried, with the exclusion of the absolutely hurtful, merely to regulate the meals and the manner of eating and drinking. Hence I think I may assert that this case may be regarded as a favorable result of the treatment with Cran. mur., and which is of all the greater weight, as the analyses were made by a third party, who is at any rate impartial. (W. Magdeburg, Brit. Jour. Hom., 1876, pp. 67-77.) Experimental studies on. Three theories on this subject. I. That sugar normally produced in organism is not burnt up in the lungs and the excess is excreted by kidneys. II. Consumption of sugar is normal but production is abnormal, and surplus is discharged by kidneys. III. Production and discharge by lungs both increased, but the latter in less de gree than former. Difficulty is to find which condition, if either prevails. Sugar being a normal constituent of the blood, the question remains, does the sugar come from intestines or from liver? Experiments seem to prove that intestinal lymph as well as the liver must be considered as original sources of sugar. (A. O., 1876, p. 401.) -Critical studies on the pathological physiology of. Experiments from I, that the liver prepares the greater part if not the whole of the sugar in the organism; and II, the glycogenic function of the liver depends on the sympatheticus. Therefore, the liver is important in the pathogenesis of diabetes. The sugar excreted by the urine is formed not alone from hydro-carbons, but also from nitrogenous substances; but it is still a mystery by which mechanism the production of sugar is increased in diabetes, whether its cause rests in the perverted function of liver or of nervous system. An ingenious theory termed "the doctrine of diathesis" is propounded by Dr. Durand-Fardel. "Diathesis fur anomalie de l'assimilation des principes immedeats," is what he calls it. (A. O., p. 409.) A report of eighty-four cases by Andral shows that diabetes is more frequent at that age when the organic functions develop their chief activity; the male preponderate. Nervous affections and impressions prevail as cause. Much food is more often the cause than absolute want, though a lack of nourishing food is sometimes the excitant. Diabetes may set in where vitality is at a high as well as at a low ebb. It frequently has a short existence at the onset of acute diseases. It may be hereditary. It may last for years with the patient in fair health, or it may run a rapid course to a fatal termination. Stagnation of pulmonary capillary circulation with passive congestion is most frequent fatal termination. The general capillary circulation is sluggish, throwing an increased amount of work on the viscera. Autopsies showed congested state of liver and kidneys, the spleen was hardened, and when cut into gave not a drop of blood. (A. O., 1876, p. 406.) And food. Arthur Scott Dankin advocates the strictly skimmed milk diet as the most possible means of cure. (N. E. M. G., vol. XI, p. 239.) Lecture on the physical character and chemical reaction of urine in. (C. B. Gatchell, P. 49, vol. III., M. I., 1876.) Therapeutics of. (G. Oehme, Bib. Hom., vol. VIII., p. 227.) |