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this method is in most cases superior to the perineal litholapaxy as long as authorities so widely disagree. With modern surgery operative treatment should have due consideration in most cases where litholapaxy is possible, and in all cases of children under 10 or 12 years of age I believe the knife should be preferred to the lithotrite.

150 North Spruce street.

With Report of Cases.


Resident Physician, City Hospital, Memphis.

The importance of the relation of albumin to the diseases of the urinary organs makes its study absolutely necessary in the diagnosis of all nephritic troubles. Although it is usually associated with other symptoms which would lead us to at once suspect the real trouble, still such are not always to be relied upon. It is only in the most recent years that the study of the urine has received its just consideration in the diagnosis of diseases. While the presence of a physiologic or functional albuminuria is generally admitted, its continued presence or its cyclic return, associated with certain other symptoms, should certainly arouse our suspicions of a graver lesion, either of the kidney itself or some other vital organ of the body, while the entire absence of albumin and casts would be conclusive that the kidney did not sustain any organic lesion, although there were other symptoms to indicate its presence. As examples I wish to report a few cases which have recently come under my observation:

Case I. Male, aged 28. Entered hospital May 26, 1899, complaining of dyspnea and a general anasarca of entire body, which had existed for one month. Examination showed extremities, trunk, scrotum and penis greatly edematous; in fact, he appeared about twice his natural size. Respiration short and accelerated, pulse slow, full and intermittent, no heart lesion perceptible, eyes glairy and protruding, bowels constipated, temperature 103° F., urine highly colored and slightly diminished in quantity, specific gravity 1025. Chem

Reported at request of Dr. J. H. Reilly, of Medical Staff, City Hospital.

ical examination showed large quantity of albumin and increase of uric acid. The microscope showed presence of hyaline, granular and blood casts with epithelium from uriniferous tubules. A diagnosis of acute nephritis was made. Treatment: Integument of scrotum was incised in several places, and prepuce also incised to relieve phimosis. Patient was placed in hot pack for two hours each day. Saline purges were given to produce watery evacuation. Infusion of digitalis, 31, and acetate of potash, gr. 10, was given every three hours; diet purely liquid. Patient improved rapidly. During first three weeks all dropsical symptoms disappeared, a week later the albumin disappeared, but returned again, and subsequent examinations showed it to be cyclic in its nature, being present for a few days then entirely absent for an equal period. At present patient has all appearances of perfect health. For the past ten days patient has been taking Basham's mixture, 3iv, four times daily.


Case II. Male, aged 30; seen first on May 17, 1899. Gave history of his sickness having begun with a chill one month previous, followed by a severe cough. One week later his feet, legs, and abdomen began swelling, and a few days afterward face became swollen-"puffy" just beneath eyes. amination showed entire body edematous, abdomen much distended, patient unable to walk on account of general edema and soreness of muscles. He could not lie down; slept sitting in a chair. Respiration shallow and hurried, pulse fast, feeble and intermittent, eyes bulging and glairy, temperature 97° F., urine diminished in quantity, specific gravity 1012, largely albuminous but showed no casts. Treatment: Stimulants of whiskey and strychnia, saline purges and hot packs every day. On following day abdomen was tapped in median line, one inch above umbilicus, and a small quantity of fluid withdrawn. Respiration was improved, but pulse continued to get weaker and faster, and in afternoon reached 200 per minute. On the morning of the 19th he was apparently better; respiration easier and pulse stronger, but about noon he raised himself in bed and fell out on the floor-dead. An autopsy was held, and revealed a greatly dilated heart, a sclerotic liver, and kidneys undergoing fibrous degeneration.

Case III. Male, aged 52; entered hospital May 16, 1899, giving a history of having had rheumatism for eight years, and was subject to malaria at various times all his life. Dyspnea was very marked; had not been able to lie down to sleep in two weeks; whole body was edematous, more especially his feet and legs; liver slightly enlarged and tender on pres

sure; heart gave evidence of a mitral regurgitation; lungs edematous, and patient coughed up great quantity of bloodstreaked mucus; urine diminished in quantity and highly albuminous; granular and epithelial casts were plentiful; respiration very feeble, and pulse intermittent; temperature 102° F. Treatment was much the same as in previous cases. The edema was relieved, especially of the lungs, but the respiration remained poor; no temperature after first week. Stomach became congested and irritable, sometimes quite painful, requiring the application of heat locally. At present, June 25, patient shows no improvement in general condition.

Case IV. Male, aged 20; gave history of having had syphilis for two years and typhoid fever six months ago. Patient complained of pain in eyes, especially in left eye; could see but little. Physical signs were all negative; pulse and respiration normal, temperature in the afternoon 102°-103° F., in the morning always normal. Examination of urine showed presence of large quantity of albumin, hyaline, granular and epithelial casts, with some leukocytes and red blood corpuscles, and layers of epithelium from uriniferous tubules. Patient has been treated both locally and constitutionally for six weeks. Sight is much improved. The albumin has disappeared, but the temperature continues to rise in the afternoon. The patient is up and feels well, except for a pain in the eyes in the afternoon.

Case V. Male, aged 21. Patient had always been in good health until two months ago, when the abdomen began to swell. Three or four weeks later his feet and legs became swollen, followed later by swelling in the face, noticed more particularly early in the morning. Examination showed abdomen greatly distended with fluid, feet and legs edematous, pulse weak and fast, liver much enlarged and tender on pressure, no heart lesion could be defined, temperature subnormal (97° F.), urine light-colored and sediment heavy, specific gravity 1006, with no albumin. Microscope revealed no casts. Blood examined showed no malarial organism. Treatment: Mercurial purge, followed by a saline; stimulants of strychnia and digitalis; hot baths every day; diet liquid. Patient recovered rapidly, and was discharged after three weeks in apparent good health.




On June 17 I was called to see a negro woman about 23 years old, second para. I was misinformed as to her real condition, but found the waters were, to a small extent, escaping. She was suffering some pain, but no further indication of labor. No softening or dilatation of either the external parts or os internum. I enjoined rest and quiet, gave a hypodermic, and left a few sedative powders. On Monday, the 19th, I was summoned again, but as I had several calls to make did not get to her home before 10:30, and then found a dead fetus about 9 inches long, with retained placenta. I endeavored by every possible means to extract the placenta, and while so doing found another fetus. I delivered this one, and, to my surprise, it was alive. It made considerable motion and attempted to, or rather did, breathe. Its sex was easily determined; they were both boys.

a hot negro

I have delivered babies at all stages of development, from an inch to full term, but never saw, heard of or read about such a case. I regret that I did not examine its lungs, but I was rather worried and fatigued, having been in cabin from 10:30 a.m. to 5 p.m. without dinner. There were two placenta, and I was compelled to use the curette to deliver both. Each fetus was 9 inches long, and I suppose the woman had gone half the term of gestation.



Mr. C., aged 40, had chills for three successive evenings, and had been taking quinine in maximum doses. At night on November 29th, after the third chill, I was called to see him. I found him suffering with intense pain in lumbar region, temperature 101° F., pulse 120, extreme nervousness, and considerable nausea. November 30, at 5 a.m., malarial hematuria developed. He had the characteristic icterus of sclerotica and cutis.

As to treatment, I first put a fly blister over liver and spleen, until it drew well. Calomel, bicarb. soda and ipecac were

given to stimulate the liver, following with epsom salts per orem and per rectum. For increase of urine I gave a No. 1 capsule of turpentine, repeated every four hours for three doses.

At noon, November 30: Drs. W. P. Conner and M. J. Alexander were with me in consultation. We gave acetate potash in 10-grain doses every three hours, as an eliminant of the uric acid; for supporting the heart, grain sulphate strych

nia hypodermatically every six hours.

December 1: Urine considerably clearer, but still having extreme nausea; temperature 100°, pulse 90, still very nervous; the treatment same as day before.

December 2: Temperature normal, pulse rate 80, urine not entirely cleared, nausea continuing. For the nausea I gave six drops of 4 per cent. solution of muriate of cocaine in listerine one-half dram, in combination with small quantity of water, to be repeated every two hours; to induce sleep, 15 grains sulphonal (Bayer) was given, to be repeated every six hours if needed.

December 3: Temperature normal, pulse rate 80, urine entirely cleared. I still continued acetate potash for several days. As a tonic, iron, Fowler's solution of arsenic, and tinct. of nux vomica were given. He made a rapid recovery.




Visiting Physician to St. Joseph's Hospital, Memphis.

Comparative Test of Mixed-Fat Emulsion and Codliver Oil. Merserau (N. Y. Med. Jour., vol. 70, no. 1) has made an investigation of the comparative merits of the Russell mixed - fat emulsion and codliver oil in the treatment of tuberculous lesions other than pulmonary. The observations cov ered a period of thirteen weeks, from November 1, 1898, to February 1, 1899, and the children were examined and changes noted weekly in regard to the following particulars: Weight, local condition or suppuration, activity about ward, color, general condition. The importance of frequent and careful examinations of the blood during the experiment was not overlooked, but was necessarily omitted on account of the lack of proper laboratory facilities, due to the unfinished condition of the new hospital buildings.

In selecting the cases, only two conditions were insisted upon: first, that constitutional treatment was required in addition to the surgical measures already in progress; second, that the child should remain in the hospital until the completion of the experiment.

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