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adopted the German treatment in any case, although he had tried various ways of reducing the temperature, quinine in ten and twenty grain doses, ice and iced water externally, but rarely baths. In a previous epidemic of typhus (exanthematic) in the Glasgow Royal Infirmary, the mortality — 11.5 per cent. — in seven hundred and three cases, under nearly expectant treatment, was thought to compare favorably with Liebermeister's statistics, which showed a mortality of 8.2 per cent. in typhoid fever under “systematic” treatment, that is both antipyretic and specific, - a marked contrast to the previous death-rate from typhoid fever at Basle, which was 27.3 per cent. under “indifferent” treatment. The returns from the Glasgow Fever Hospital, given by Dr. Russell, showed a rate of mortality in typhoid fever varying from six to 14.8 per cent., the treatment, as stated, being nearly expectant, and all cases included. Professor Gairdner intimated that the low death-rate at Basle was due in part to the exclusion of moribund and other patients not deemed suitable for "systematic” treatment. Other members of the society agreed with Dr. Gairdner in thinking that their own treatment was far superior to the German method, which was characterized as " utterly bad” and reprehensible. Dr. McCall Anderson, however, thought that although the antipyretic treatment was not likely to be transplanted to Scotland in its integrity, it was of great value if carried out with due caution. The real danger consisted in allowing the treatment to be pursued too far. He stated that almost all cases of rheumatic fever which proved fatal died from the high fever, and that there were many cases of typhus and typhoid which died from the same

cause.

Professor Liebermeister, in a letter to Professor Gairdner in reply, after expressing his dislike for literary polemics, writes as follows : “ You have no experience of your own of the working of the antipyretic treatment. You have hitherto used it in a way which, as you rightly judge, I would designate as wholly insufficient. You are, as you frequently say, ' open to conviction,' but how are you to be convinced if you yourself make no observations, and, besides, exercise your authority, justly so highly valued, to prevent others from making such trials? . . . What has been proved useful everywhere in Germany will not be hurtful in Great Britain. ... As I read the extract which you have given

article, I could not be astonished if your audience should have shuddered at the antipyretic treatment. It looks as if with us each patient was treated with innumerable baths, immense doses of calomel, quinine, digitalis, and veratria. Such is not the case. who, when the preservation of life demands it, makes a free use of the knife does not therefore cut off a leg from every patient who comes to him. The antipyretic treatment is not, as you believe, a matter of

i Glasgow Medical Journal, November, 1878.

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routine. On the contrary, with it the cases are more individualized than with any other method of treatment. Each agent is used only when necessary: and when none is necessary none is used. But in order to know what is necessary one must of course observe each individual patient much more thoroughly than has hitherto been customary. It is just the routine hitherto pursued, for which we propose to substitute a method of close observation very exacting on the inedical attendant, which offers the greatest obstacle to the introduction of the antipyretic treatment."

With reference to the value of the statistics at Basle Professor Liebermeister says: “ We reckon as having died of typhoid every patient who was in the hospital with typhoid and did not leave the hospital living," and he is inclined to think that the mortality at Glasgow might be still lower if the antipyretic treatment were adopted, as was the case at many places in Germany where typhoid fever had previously been much less malignant than at Basle. At Kiel, for instance, the death-rate was shown by Jürgensen and Bartels to have been reduced from fifteen per cent. to less than five per cent.

Professor Gairdner's rejoinder reiterates the necessity of caution in adopting, as a routine method, treatment which in his opinion would appear to be often injudicious.

Dr. G. C. Smythe, in a paper on antipyretic methods as applied by him in eighteen cases of typhoid fever in Indiana, reports but one fatal result, which occurred in a man sixty-two years of age, after relapses. Ten cases were treated with full doses of quinine, and the remaining eight with quinine and cold baths combined, in one instance thirty-one baths being given during the first week. The author, regarding the degeneration of vital organs from long-continued and unremitting fever heat as the chief source of danger, considers cold baths and quinine indispensa. ble, the latter the more valuable of the two. He calls attention to the fact that “the morning remission does not take place again after the administration of quinine until the fever heat approaches the point touched by the morning remission for that particular case when uninfluenced by treatment.”

Salicylic Acid as an Antiseptic and an Antipyretic. — Mr. Prideaux, after treating with large and continued doses of salicylic acid eightyeight cases of confluent small-pox with no deaths, the subsequent pitting being also absent, twenty-eight cases of scarlet fever with but one death (some of the cases being very severe), numerous cases of measles and a few of typhoid fever with no fatal results, thinks it probable that "the action of salicylic acid in destroying the lower forms of animal life may be and is of use in restraining the activity and increase of the bioplasmic

1 The American Practitioner, January, 1879. 2 The Practitioner, September, 1878.

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grs. v.

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particles which appear to be the accompaniment, if not the cause, of py-
rexia, as well as in destroying their morbific and contagious influence.”
From an experience of forty cases of acute rheumatism the author
concludes that the action of the drug is almost specific. Certain incon-
veniences which have been sometimes alarming in nature, such as col-
lapse, delirium, etc., are attributed to want of caution in using large and
continued doses, or to the impurity of the drug. The use of salicylate
of ammonia is thought to obviate the tendency to collapse due to rapid
fall of temperature, and the following prescription, which seldom cåuses
nausea, is recommended :-
R Sodæ bicarb.

Ammoniæ carb.
Acid salicylic.
Aquæ

ad fzi. M. Frits Levy 1 concludes, from experiments at the Frederiks Hospital in Copenhagen, that salicylic acid in the proportion of from one to two per cent. is efficient in arresting fermentation and as a preservative of urine, serous fluids, etc. The salicylates do not have this property. Eighty-one cases of rheumatic fever were treated with salicylic acid in doses of from seven to fifteen grains an hour, or with salicylate of soda in somewhat larger amounts. The average quantity of acid for each patient was 330 grains, the maximum being about 2900 grains, the minimum 75 grains. The following constitutional symptoms were noticed : sweating in 86 per cent., ringing in the ears 77 per cent., deafness 7 per cent., nausea 22, and vomiting 13 per cent. The use of the acid had to be abandoned in about 9 per cent., always in feeble individuals with chronic maladies, twice for dyspnea, twice for vomiting, and once each on account of nausea, diarrhea, and nasal hæmorrhage. In 17 cases, in which previous cardiac complications existed, salicylic acid was well borne, a certain degree of caution being observed in aged and feeble individuals. In about 10 per cent. of the cases the acid had no effect upon the progress of the malady ; in the others there was decided benefit. In comparing this series of 81 cases with an equal number of similar cases treated with alkalies and opium, the author finds that the fever abated, on the average, in six days instead of twelve without the acid; the pain in five days instead of thirteen; the average duration of the illness also being reduced from thirty-seven to twenty-eight days. The earlier the cases came under treatment the more satisfactory was the result. Cardiac affections appeared in 8.6 per cent., and mild delirium in 3.7 per cent.; whereas, in those cases not treated with salicylic acid, organic disease of the heart supervened in 20.5 per cent., cerebral troubles in 18 per cent., and pleurisy in 10 per cent. None of the patients treated with salicylic acid died, but among the others the mortality was 7.6 per cent.

i Nordiskt Mediciniskt Arkiv, Band x., No. 18.

een.

In conclusion, the author remarks that salicylic acid is inferior to quinine as an antipyretic, and that in rheumatic fever, although not a specific, it is a most valuable addition to our therapeutic resources.

Professor C. Reisz, of Copenhagen,reports 88 cases of rheumatic fever treated with salicylic acid during twenty-three months, and compares them with 134 cases under the former methods of practice in the previous two years. There was no death among those who took salicylic acid, while in the other series were four fatal cases. The duration of the disease, dating from the time the patient went to bed until he was discharged from the hospital, was thirty-five days instead of thirtynine days, as formerly, the fever subsiding in six days instead of eight

The proportion of heart affections in the first biennial series was 43 per cent., of which 28 per cent. developed into permanent organic disease, against 11 per cent. under the salicylic-acid treatment, only two cases, however, being of considerable severity. Pleurisy and pneumonia, which occurred in more than 10 per cent. of the earlier series, did not supervene in any instance when salicylic acid was employed. Relapses were frequent, but of short duration. The acid had to be omitted twice for profuse diarrhea, twice for vomiting, and once each on account of nausea, epistaxis, and dyspnea. Parenchymatous nephritis was not aggravated by its use.

Rheumatic Pleurisy. — M. Fernet (Hôpital Saint-Antoine) 2 mentions a case of double pleurisy with abundant effusion in a patient who had acute articular rheumatism in many joints. The dyspnea was such

. that thoracentesis was performed the day after entrance. On the removal of part of the fluid from one side (750 grammes) the rest of the effusion in that side, as well as all of that in the opposite, was absorbed in a few days, and the patient recovered. This rapid absorption in cases of rheumatic pleurisy as compared with effusions from other causes has been frequently observed.

Renal Complications in Rheumatic Fever. - Attention has been called to the occurrence of albuminuria during the progress of rheumatic fever treated with salicylic acid, but it has not been apparent that this symptom was the result of the use of that drug. In this connection the following case, reported by M. Bucquoy at the Hôpital Cochin, 3 is of interest. A young man, seventeen years old, entered the hospital with a second attack of acute articular rheumatism soon after its onset. The pain, which was very intense, appeared to be relieved by salicylate of soda, but there was great dyspnea. After several days of treatment with diminished doses, the patient being apparently in a very satisfactory condition, he died suddenly in a renewed attack of excessive dyspnea.

i Nordiskt Mediciniskt Arkiv, Band ix., 1878. 2 L'Union médicale, No. 4, 1879. 3 L'Union médicale, No. 4, 1879.

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The autopsy showed great inflammatory congestion of the kidneys with commencing fatty degeneration. The sudden death was thought to be due to uræmia, and although it could not positively be attributed to the remedy used, care in examining the urine under such circumstances was recommended.

Bright's Disease. Professor Charcot, in a valuable course of lectures,' again calls attention to the multiplicity in the forms of Bright's disease or diseases, indicated clinically as well as anatomically, and as set forth during the past twenty years, especially in Great Britain, by Dickinson, Grainger Stewart, Johnson, and others. Parenchymatous nephritis, characterized by the large white kidney, Bright's kidney par excellence, is regarded as a disease of relatively rapid evolution, usually not more than a year, occurring rarely in old subjects, but often in younger ones, accompanied by dropsy, scanty albuminous urine, which is often of normal specific gravity, and contains many hyaline casts. The epithelium of the kidney is chiefly affected, and uræmic symptoms are not very frequent. In interstitial nephritis, on the other hand, which is a genuine cirrhosis of the kidney, the connective tissue being primarily involved with atrophy of the cortical substance (small red kidney, granular kidney, gouty kidney), the author states that subjects succumb at a later age, often between fifty and sixty, after a chronic illness of perhaps ten years, during which dropsy is absent, until a late period at least, in more than half the cases. The urine is abundant, of low specific gravity. There may be no albumen and no casts. The cases generally terminate in uræmia. Hypertrophy of the heart without valvular lesion and albuminous retinitis are common, the latter almost peculiar to this form. Among the uræmic accidents of interstitial nephıritis are habitual dyspepsia with persistent vomiting, temporary or permanent blindness without appreciable retinal changes, headache, vertigo, and tremors. These affections may be present for a long time, with negative urinary symptoms. It has often been noticed that the urine of sub- . jects of interstitial nephritis does not convey the violet odor transmitted by preparations of turpentine, or the peculiar smell from the use of asparagus. In the same manner the kidney seems to be impermeable to opium, of which small doses have produced fatal coma. Small doses of calomel also may cause profuse salivation. Professor Charcot does not assert that the same accidents may not occur in parenchymatous nephritis, or that the two forms may not coexist. He states that the significance of casts has been greatly exaggerated, and after pointing out the frequent occurrence of epithelial casts in various acute diseases, or after the use of diuretics, and of hyaline casts in normal urine, but more especially in cases of jaundice, he says that casts in general are not, as

Lectures on Bright's Discase of the Kidneys. American Edition. Translated by Henry B. Millard, M. D. New York: William Wood & Co. 1878.

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