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bacilli, mucin, leucocytes, etc., analagous to the formation of gall-stones) occur as often as 1 out of 3 cases. True foreign bodies (orange pips, shot, pins, peanut, apple pips, grape seeds, etc.) occur in about five per cent of cases. Actinomycosis of the appendix may also occur. Tumors and malignancy occur in the appendix in 1 in 1,000 to 1 in 3,000 cases of appendicitis. Dr. Goluboff thinks that appendicitis is a direct infection (sui generis) of the appendicular follicles, as we find in tonsilitis and dysentery. Heavy French dinners, over-eating and indigestion, will no doubt account for most cases of primary attacks of appendicitis.

AN UNUSUAL CASE OF BRADYCARDIA.

By LUCIEN LOFTON, A.B., Ph. G., M.D., Belfield Emporia, Va.; Ex-
President of the Seaboard Medical Association of
Virginia and North Carolina.

A most interesting specimen of Bradycardia presented itself at my office, a few weeks ago, the subject being William Henry Gary, a well-developed colored man, without unusual family or personal history. He is 29 years of age, weighs 187 pounds, is six feet three inches in height, enjoys good health, and earns a livelihood by farming. Both speech and motion are very slow and decisive, but he is agile and as virile as any man you meet. Three distinct examinations were made of his cardiac organ while standing erect, and each showed only 44 pulsations of the heart, while as many more were made sitting, and these registered from 3 to 5 beats less. While the full recumbent posture showed that the heart's action was only 32 to 33 to the full minute. The volume, regularity and force were good at each count. He never suffers from dyspnoea, giddiness or palpitation, and stated he had often remained under water when a boy, while bathing with companions, twice as long as any of the rest. He says he can run, walk and work as hard as any ordinary man of his acquaintance, and never experiences any inconvenience whatever. The organ is normal physically. Up to the time I examined him he was ignorant of his condition.

THE FREEZING POINT OF URINE.

[As showing how difficult is the employ ment of "Cryoscopy" by the general practitioner, we reproduce the following article in full.—ED.]

By W. G. TURNER, B.A., M.D., Medical Superintendent, Montreal General Hospital.

Cryoscopy may be defined as the science which deals with the determination of the freezing point of the fluids of the body, notably the blood and the urine; its clinical value consists in the comparison of the freezing point with the observed normal of a series of cases.

The apparatus employed is of German origin, and consists of a series of tubes, one inside the other; from without inwards these are filled with (1) a freezing mixture of ice and salt, (2) air in a jacket, which becomes gradually cooled, and (3) urine. To prevent absorption of moisture from the air in contact with the freezing urine, air passed through sulphuric acid is constantly supplied to the innermost tube. Glass rods allow of constant stirring of the freezing mixture, and determination of the degree of fluidity of the urine which is being tested. At every employment of the apparatus a sensitive thermometer is used, which is first immersed in freezing mixture until its standard zero is determined and noted; the urine is then frozen and its freezing point determined; after each experiment the standard zero is again verified by a control observation.

It will be understood, then, that the object of the experiment is to decide the amount (a fraction of a degree) of variation of the sample of urine or blood tested, from the freezing-point of normal urine or blood, decided from a large number of observations.

As the experiments carried out deal entirely with urine, I shall refer but briefly to the results of blood determination. It must be borne in mind that a moderately large amount of blood (10 cc.) is required; this is, in itself, a decided drawback, as the unwillingness of the patient must be considered, and the employment of proper sterilization of the skin and the required hypodermatic syringes render it essentially a practice suitable only to hospital work.

From a large series of cases, Kummel has decided that the freezing-point of normal blood is .56° Celsius under

that of distilled water; it may vary from .55 to .57°, but practically never more.

This freezing-point, further, is unaltered in many cases of severe systemic disturbance and in inflammations of the genito-urinary tract where there is no actual incompetency of kidney tissue; should incompetency of kidney tissue, however, be present, a change, be it less or greater, does occur in the freezing-point, the alteration being always in the direction of lowering of the reading. In systemic diseases, with high fever, even in typhus, Rumpel is authority for the statement that no change occurs; Epstein's assistants report the contrary, and it has occurred to me that the variance of result may be due to the presence or absence of kidney lesion in the course of the acute febrile disease.

In no case where much kidney tissue was thrown out of usefulness, was the freezing-point of the blood normal, and in no case where a patient's blood showed a decided lowering, was the result of surgical operation good; on the contrary, where the surgeon temporized until the blood point rose to normal or nearly normal limits, the results (in this series of cases) were favorable. Practical deduction can thus be made: Does the blood show a decidedly lowered freezing-point, do not operate, for it means incompetent excretion. Wait until the freezing-point rises (that is, until kidney competency is restored); if it does not rise, the prognosis is bad.

* * * *

Further, should a low freezing-point of blood be present, suspect kidney incompetency (calculous nephritis, chronic interstitial nephritis, tuberculosis nephritis, the various nephroses, etc). As to means of localization, we shall presently speak; it suffices to say that the blood freezing-point may thus indicate kidney disease, hitherto unsuspected, or may show the amount of affected tissue in a case where it has been previously known to exist.

It will be understood then, that the lowered blood freezing-point indicates that excretion is imperfect. A sure supplementary test, upon which Casper, of Berlin, has lately insisted as an auxiliary to cryoscopy, is the well known employment of Phloridzin, which is excreted as sugar by the kidney; the less sugar produced, the greater is the involvement of kidney tissue, but if we

decide that a certain amount of kidney tissue is destroyed, (e. g., in a case of tuberculous nephritis), the question arises: "Which kidney is diseased? or are both?" Ureteral catheterization must here come into "play " and the quality of the urine from each kidney must be determined; a careful examination by ordinary laboratory means is essential, and may be sufficient to localize the disease. The urine from each kidney must be separately frozen, and the lower freezing-point of the two specimens determines the side of greater tissue-destruction.

To determine the freezing-point of the urine in cases of various diseases, and, if possible, to find out what bearing they had upon the freezing-point of the urine, I made, by the advice of Dr. Armstrong, a series of observations upon different urines, from medical and surgical cases; as yet, no specimen from the ureters have been examined; all specimens from female cases were taken by catheter.

The process is tedious, and is essentially a laboratory experiment. The investigator will find it necessary to make preliminary tests to thoroughly familiarize himself with the procedure. The series, to the present, has consisted of 70 cases, of 51 of which I append the results.

The amount of solid, indirectly the number of molecules, in the urine determines, to some extent, the freezing-point -the greater number of molecules, the lower is the reading. While it was realized that the lowest freezing-points would be found in cases of greatest concentration (that is, in partial anuria, due to advanced degrees of disease), it was felt that it would be premature to begin with these cases, without having a table of more or less nearly normalappearing urines; therefore, all the cases selected were those of practically undiminished amount.

It was found that specific gravity does not seem to bear any constant relation to freezing-point; as specific gravity varies according to the kind of molecules, and freezingpoint according to the number of molecules-this is what might be expected.

I do not feel justified in inflicting upon you a meaningless list of figures.

The figures for normal urine are stated, by Caspar, as lying between 1 and 2° Centigrade; ten normal urines

varied between .09 and 2.28, the same individual, presumably healthy, varying at different times. Five cases of trauma, all severe, gave consistently high freezing-points, varying between .03 and .76. Three cases of extensive loss of blood varied from 1.45 to .53, the reading being highest. where the loss of blood was greatest. Extensive infections, eight in number, were high between .04 and .67, but abdominal infections were more variable, six varying from .05 to 1.62, the majority being low. Five typhoids were consistently low, from 1.26 to 1.99.

Of nine kidney cases, with fair amounts of urine, the point was between .74 and 1.97, apparently the limits of fairly good kidney tissue; five recovered, or are improved, one died, but autopsy showed a septic nephritis, with numerous pin-head abscesses, but withal very little destruction of kidney tissue. Of this case the reading, as might be reasonably expected, was an average one-1.14.

The other cases (including ulcerations, abscesses, tuberculous and new growths with no kidney lesion), I fail to classify intelligibly, and I may, therefore, omit particulars.

I have spoken of the results of this series to indicate the variations met with, and the great uncertainty of the results I have obtained; one dare not on such premises, draw any conclusions. I trust, however, that to counterbalance the infertility of my own work, I may have indicated, however obscurely, the trend of work and of opinion in these directions.

I beg to thank Dr. R. C. Paterson, of the interne staff, for assistance in the work.-Montreal Medical Journal, for January, 1903.

THE next annual meeting of the American Electro-Therapeutic Association will be held at the Hotel Windsor, Atlantic City, N. J., September 22d, 23d and 24th, 1903.

THE Journal of Nervous and Mental Disease, of which Dr. Smith Ely Jelliffe is the able managing editor, has issued a Directory of Private Institutions for the Treatment of Nervous and Mental Disease. It comprises all the principal private sanatoria in the United States, and will prove of value to physicians desiring to direct their patients to these institutions.

VOL. XLVI-10

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