On the Use of Erythroxylon Cuca in Typhus and Typhoid Fevers and also in others Febrile Diseases. By SAMUEL MCBEAN, of Newcastle-on-Tyne.-Mr. McBean introduces his paper by observing that in all febrile diseases, with the exception of yellow fever, the amount of urea formed is abnormally increased, and, as was first observed by Dr. Ringer, the amount of this substance excreted stands in a certain relationship to the temperature of the body. Hence, as urea represents the wear and tear of the system, its amount may be regarded in fever as affording, not only an index to the severity of the disease but also a direct clue to a very important line of treatment. He goes on to argue that, as in fever there exists a specific morbid agency leading to an undue extent of tissue metamorphosis (as indicated by the increased quantity of urea excreted) it is desirable to restrain such metamorphosis until the morbific agency has ceased to exist. In the accomplishment of this object he believes that cuca is a very efficient agent, this substance consisting of the dried leaves of the Erythroxylon cuca, and having, when taken by a healthy person, the power of diminishing the excretion of urea. In this property, according to Mr. McBean, lies the value of cuca as a therapeutic agent. The author gives three cases in which the drug was successfully employed, although in the first of these the patient, after being convalescent from typhoid fever, died of a supervening attack of lobular pneumonia. In all the cases, the administration of the cuca appeared to be followed by diminution of temperature and relief of the symptoms, and in the first case the degree of temperature, the rate of the pulse and of the respirations, and the relative quantity of urea excreted are all accurately recorded. Mr. McBean has found cuca also serviceable in both acute and chronic pneumonic phthisis, and, where there is much febrile excitement, this drug lowers the temperature and restrains or materially alleviates the distressing perspiration. The modes of administration of the cuca are in the tincture (the dose being a drachm or a drachm and a half) or in infusion of the leaves, and Mr. McBean states that he has obtained the tincture from Messrs. Hewlett and Son, of Leadenhall Street, London.-British Medical Journal, March 10th, 1877. REPORT ON PATHOLOGY AND THE PRACTICE OF MEDICINE. BY JOHN T. ARLIDGE, M.D., A.B. Lond., F.R.C.P. Lond., Plessimetric Auscultation.-Dr. Noel Gueneau de Mussy has noted that when the ear is applied to the upper portion of the front of the chest, and percussion is made on the upper dorsal spinous processes, a peculiar metallic vibration is heard over and above the sound produced by the tap itself. The like phenomenon transpires when the sternum is percussed and the ear applied to the upper and posterior part of the thorax. The name proposed for this sound is plessimetric transsonance," and the process "plessimetric auscultation." This plan of exploration is not new, for Trousseau employed it for the diagnosis of pneumothorax, and noted the existence of a brassy sound as elicited in this malady by this mode of percussion. M. de Mussy, however, points out other clinical applications of the proceeding. For instance, when the pulmonary tissue is modified in density and permeability, leading to defective homogeneity of the medium through which the waves of sound are transmitted, the sound, which in the normal condition is vibrating and metallic, is rendered more dull and feeble, although its pitch is at times simultaneously raised. In this way central lesions of the lung which escape detection by percusssion as ordinarily practised may be diagnosed, such as, for example, tubercular indurations at the apex, bronchial adenopathy, and centric pneumonia. At the level of the inferior lobes of the lung, the liver on the one side and the heart on the other arrest the sonorous undulations. From this circumstance we acquire a means of determining the upper limit of the liver and the situation of the heart, because on the level of either viscus there is a sudden change of the transresonance.-Hayem's Revue des Sciences Médicales, 1877, p. 130. Renal Changes in Gout.-Litten relates a case of gout curiously occurring in an ill-fed pauper, in whom no hereditary tendency was discoverable. The patient rapidly succumbed to a well-marked attack of gout ushered in without any premonitory attacks. The urine was clear but scanty and highly albuminous, without sediment or preformed elements. Considerable anasarca and fluid in the serous sacs; no cardiac lesion. The symptoms were not those of renal atrophy, and, in the absence of enlargement of the spleen and of diarrhoea, those of amyloid disease were also wanting. Nevertheless, the autopsy revealed very advanced amyloid disease, with simple atrophy. Such form of renal lesion has hitherto not been described in gout, but Litten believes it will not be found so rare if looked after, particularly in acute cases, because it has as yet escaped notice by reason of the amyloid change being readily mistaken for simple atrophy of the kidney. In this same patient another very unusual fact occurred, viz. the presence of deposits of urates (tophi) in the larynx; however, as was still more remarkable, these deposits were unaccompanied by any alteration of the voice. -Archiv fur path. Anatomie, Band lxvi, p. 129; and Hayem's Revue des Sciences Médicales, tome ix, 1877, p. 68. Excretion of Oxalid Acid in the Urine.-Dr. Paul Fürbringer, of Heidelberg, has conducted a large series of experiments on the excretion of oxalic acid in the urine, and on the causes influencing its amount. The résumé of the conclusions whereat he has arrived is 1. Oxalic acid is a normal and probably a constant constituent of the urine. 2. The excretion of oxalic acid in the urine rarely exceeds (where an ordinary mixed diet is used, devoid of excess in oxalates, and there is a fair amount of activity) 20 milligrammes per day. 3. The quantity of oxalate of lime contained in the sediment of the urine bears no necessary relation to the entire amount present in the urine, even when this has been allowed to stand for twenty-four hours. The difference between the two exists in solution. In fact, urine occurs in which no signs of crystals of oxalates can be discovered, even after it has stood twenty-four hours, but which, notwithstanding, is really richer in oxalic acid than other urine, in the sediment of which numerous crystals of oxalate of lime are visible. 4. The most active solvent for oxalate of lime in the urine is the acid phosphate of soda. The smaller the degree of the acidity of the urine, the closer does the proportion of the precipitate oxalate of lime approximate to the entire quantity of that salt existing. 5. The internal administration of bicarbonate of soda does not augment the proportion of oxalic acid poured out in the urine. 6. The ingestion of lime water in moderate doses does not increase the excretion of oxalic acid. 7. The introduction of uric acid salts does not necessarily increase the oxalic acid discharged with the urine. 8. There is no constant relation between the extension of oxalic acid in higher proportion with the urine and an arrest of the normal oxidation process in the organism. 9. Fever does not exclude the occurrence of a self-produced discharge of oxalate of lime with the urine.-Deutsches Archiv, Band xviii, p. 144. The Pathology of the Accumulation of White Corpuscles in the Cortical Substance of the Brain.-Duke Charles, of Bavaria, who is a doctor of medicine, has instituted a series of investigations respecting the accuracy of the assertion of Popoff, that in typhoid fever and in the later stage of typhus the most noteworthy circumstance in the cortical substance of the brain is an accumulation of white corpuscles, not only in the vicinity of the ganglion-cells, but also within those cells themselves; and that, as a consequence, there ensues a tendency to the breaking up of the cell-nuclei. In these presumed morbid changes Popoff, moreover, found an explanation of the disturbed cerebral phenomena attending the diseases in question. To fairly test the accuracy of Popoff's statements, Duke Charles at first followed out precisely his method of making the preparations of cerebral matter and of examining them, but experience soon showed him that this method gave very unsatisfactory and indefinite results. He consequently next resorted to other methods, which gave clearer insight into the matter in dispute, and convinced him that, although a collection of white corpuscles existed, none such were present within the ganglion-cells, and that the nuclei of the last did not undergo fission. He further proceeded with a much wider range of inquiries than Popoff, investigating the brain substance in fever at all stages, in a variety of general and local diseases, and in animals in a state of health. Altogether he examined fifty different brains and 500 preparations made from them. The general result was, that these white corpuscles are always to be found in the cortical substance, but that their relative quantity varies in different brains and in different diseases, being greater in those maladies in which those corpuscles are produced in excess, and also in those wherein the circulation is retarded. With reference to the position of the multiplied corpuscles, it is to be admitted that these bodies are especially collected around the ganglion-cells, and often press upon them, and, thrusting in their wall, are lodged in pouches so formed, but without gaining their interior. A second locality in which the corpuscles abound is the lymph-spaces of His. On the other hand, they are few or quite absent in the general substance of the brain or in association with neuroglia-cells, except, indeed, in cases of meningo-cephalitis; and the idea suggests itself that between the perivascular spaces and the circumference of the ganglion-cells a system of communicating canals is in existence. Obersteiner, indeed, advanced this opinion, and stated that he was fortunate in being enabled to inject the periganglionic space from the perivascular canals. From the preceding observations the hypothesis may be hazarded, that the phenomenon of accumulation is due to an emigration of white corpuscles from the blood in circulation—a known result of inflammatory action. Moreover, it is an admitted fact that the multiplication of white corpuscles goes along with an increase of the aqueous constituents of the blood and with retarded circulation; and this holds true, not only with regard to cerebral matter, but likewise to other organs the subjects of the same morbid condition. Especially is this fact exhibited in the liver. The résumé of conclusions is 1. That in the cortical substance all brains, even of the healthiest, there is a considerable number of white corpuscles. 2. Retarded circulation and an increase of water in the blood bring about an increased production of white corpuscles. 3. These bodies exist in the perivascular canals of His, in the adventitial canals of Robin, and pre-eminently in the periganglionic spaces. 4. They never penetrate within the ganglion-cells themselves, and do not give rise to division of the nuclei of those cells. 5. The cerebral symptoms depend in no instance upon the presence of the white corpuscles, nor upon their multiplication, nor upon retarded circulation and an increase of watery constituents, when these constituents are of slow access and lingering; but they must be attributed to an acute augmentation of all three morbid conditions, wherein consequently a process of fever and the exciting cause of fever assume the character of factors.-Virchow's Archiv, Band lxix, 1877, p. 35. Chemical Discrimination of Alkaline Salts of Urine.-Dr. C. Stein, in a paper on alkaline urine and its occurrence in stomach disease, refers to the difficulty frequently experienced in discriminating between the several salts that occur in alkaline urine. He notes that dilute acetic acid is insufficient, and that, although ammonia acts upon the phosphate of magnesia, and apparently leaves triple phosphate and phosphate of lime unchanged, it does not clearly establish the difference between the phosphate of magnesia and triple phosphate, and fails, even after a long interval, to differentiate between triple phosphate and calcium phosphate. On the other hand, he finds a solution of commercial carbonate of ammonia, prepared with gentle heat, in the proportion of one part to five parts of water, an efficient reagent to distinguish between the three sedimentary deposits in question. On placing under the microscope a small portion of each of the three substances, or on introducing a larger quantity in a test-tube, and adding the solution in question, it is found that the crystals of the triple phosphate remain unchanged, their angles and sides continuing as sharp as ever, and their transparency as decided. However, after submitting them to the action of the solution for a day their lustre dims, and a waxy appearance is assumed, the surface looking to be pitted by small holes; nevertheless, even after the lapse of seven days, some few crystals will still be found. On the contrary, the crystals of magnesium phosphate are immediately altered. The transparent clear laminae become forthwith dull, and in a few minutes the edges become jagged and the entire surface speckled. After forty-eight hours some clusters of crystals, looking like skeletons of their former selves, may be seen, and with them numerous very small angular crystals. The phosphate of calcium, on its part, at once loses its sharp contour, yet does not dissolve and disappear, but seems to be transformed into a multitude of very small spheroidal particles, closely resembling the globules of my coderma aceti. These particles cohere in masses, adherent to the object-glass, and may be collected from it unchanged, even after rinsing. They are readily soluble in hydrochloric acid, and after the lapse of several hours they assume an irregular figure, and after a longer interval the character of true crystals. It is true that similar small angular crystals result from the prolonged action of the reagent on magnesium phosphate, but these do not adhere to the glass, as do those of calcium phosphate, but are readily washed away by rinsing. Further experiment showed that artificially prepared crystallised 118-LIX. 31 |