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OBSERVATIONS WITH REFERENCE TO THE VALUE OF METHYL-VIOLET AS AN INDICATOR OF THE PRESENCE OF FREE HYDROCHLORIC ACID.
THE general use of methyl-violet in the colorometric method of studying stomach fluids with reference to the presence or amount of free hydrochloric acid, renders important a precise estimate of the value. of this color reagent. Within the last six months, the relation of this reagent to the amount of free hydrochloric acid present in the stomach liquids, has been comparatively studied by the writer in more than 600 different stomach fluids. In a few of these, the data observed were not quite complete, so that they were thrown out, leaving 567 cases to which the statements made in this article refer. Of these 567 cases, free HCl was indicated as absent in 86 (15 per cent), and present in very small quantity in 57 (9.9 per cent). The reaction was decidedly marked in 325 (56.4 per cent) cases, and was very marked, indicating excess of HCl, in 108 (18.7 per cent) cases. In each case in which the color reagent was used, a careful quantitative analysis was also made, in which the total chlorine was determined as well as the amount of chlorine in the form of free HCl. Quantitative analysis showed free HCl to be absent in only 8.6 per cent of the cases,- a trifle more than one half the number of cases in which the color reagent indicated it to be absent. The quantitative estimation indicated HCl in excess, that is, in a quan
BATTLE CREEK, MICH., MAY, 1893.
tity greater than 50 milligrammes of anhydrous HCl in 100 c. c. of stomach fluid, in 146 cases, or 25.3 per cent.
These figures indicate sufficiently the inaccuracy of methyl-violet as an indicator of either the absence or the relative amount of free HCl present, since free HCl was present in nearly one half the cases in which it was indicated to be absent by methyl-violet, and the reagent failed to indicate excess in nearly as large a proportion of the cases in which decided excess existed. But a careful study of the cases in which free HCl was indicated to be absent or in excess, in comparison with cases in which the actual facts were determined by quantitative analysis, shows a most astonishing lack of coincidence; for example, of the 86 cases in which methyl-violet indicated the absence of free HCl, the acid was found present in 54, or 62.9 per cent, of the cases. In a majority of the cases in which free HCl was present, although indicated to be absent by methyl-violet, it was present in a quantity of from 4 to 8 milligrammes for each 100 c. c. of stomach liquid. In ten cases the amount of free hydrochloric acid reached from 16 to 18 milligrammes per 100 c. c. of stomach fluid; in one, 36 milligrammes; and in another, 40 milligrammes. The average of 18 cases was nearly .018 grammes, a close approach to the normal amount. Certainly, from the pathological indication in these 18 cases, positive damage might have been done by the administration of hydrochloric acid, al
though the methyl-violet test indicated the necessity for the use of this drug.
The results of the comparison were equally bad in cases in which an excess of free HCl was indicated by the methyl-violet test. Of 108 cases in which the color reaction was very strongly marked, quantitative analysis showed excess, that is, more than 50 milligrammes in 100 c. c. of stomach fluid, in only 6 cases (5.5 per cent), while free HCl was totally absent in 8 cases.
It is thus apparent that as an indicator of excess, the methyl-violet reagent fails much more frequently than it succeeds, and hence, if used at all, should be interpreted negatively, the failures being 7.4 per cent of the cases, or one third more frequent than the successes. study of all the cases showed that free HCl was absent in 21 cases in which methyl-violet showed it to be present. Of these, acid fermentation was present to a very marked degree in 8 cases. The reaction for lactic acid was distinctly marked in 9 additional cases, and in the remaining 4 cases in which neither fermentation nor lactic acid was indicated as present, there was a great abundance of peptone. As lactic acid is almost invariably present in connection with fermentation in the stomach, it is probable that this is at least one of the substances which interfere with the color reaction of methyl-violet as an indicator of free HCl.
The above facts seem to indicate beyond controversy the unreliable character of methyl-violet as a color indicator, and to condemn its use as a reagent in the examination of stomach fluids. Günzburg's reagent, and the resorcine reagent of Boas, are much more reliable, and, as a rule, may be depended upon as indicators of the presence of free HCl.
The reason why Ewald finds so many cases in which free hydrochloric acid is absent, is to be found in the explanation which he himself gives in explaining another anomalous fact, which he says is
"due to the incompleteness and coarseness of our present methods." This explains another fact mentioned by the translator of Ewald's work, Dr. Morris Manges, namely, "the surprising number of such cases recently reported in the various medical journals without correspondent constitutional symptoms." "Such cases " refers to cases in which a diagnosis of atrophy of the stomach has been made.
In the study of 700 stomach fluids by the exact methods of determining quantitatively the amount of free hydrochloric acid present in the gastric juice, devised more than half a century ago by the eminent Prof. Golding Bird, of Guy's Hospital, London, Eng., and recently perfected by Hayem and Winter, of Paris, I have found free hydrochloric acid absent in only 52 instances, and in not a single instance has free hydrochloric acid been found to be absent without very distinct evidence of ill health, in disordered digestion.
Examinations of stomach fluid have frequently been made in women during the menstrual period, but in no instance has free hydrochloric acid been found absent. The reason for these numerous errors in observation, which are so misleading in diagnosis, is to be found in the unreliability of the color-tests for free hydrochloric acid, especially the methyl-violet test, which, as already shown, not infrequently fails to indicate. the presence of free HCl, although it may be present in a considerable quantity in the fluid examined.
Physicians have frequently found themselves in disgrace from basing a diagnosis of atrophy or cancer of the stomach upon the absence of free HCl, as indicated by methyl-violet, and have thereby been led to discredit the value of all chemical methods of investigating stomach disorders. It is safe to say that the colorometric methods are wholly unreliable, except as giving suggestive indica
tions, which in a majority of cases are of some value, although not infrequently the indication given is the opposite of the truth. I shall give, at some future time, a more complete account of my investigations in this direction.
GRAPHIC STUDIES OF THE SINUSOIDAL AND OTHER FORMS OF ELECTRICAL CURRENTS.
(Continued from January No.)
THE motor effects are obtained by running the apparatus at a slow rate of speed; that is, a speed giving alternations of the current varying between 50 and 150 per second.
Sensory Effects.-The sensory effects are obtained by running the machine at a high rate of speed, securing alternations of 100 to 200 per second. The effect of the current upon the sensory With is equally remarkable. sponge electrodes applied to the temples, the machine being run at a high rate of speed and the current controlled by a rheostat, a most remarkable display of light impressions is observed in the vicinity of each pole, the impression being that of moving circles concentrically arranged. The appearance might be not inappropriately compared to a great whirlpool of light. Absolutely no other sensation is perceived with a current of moderate intensity. As the intensity of the current is increased by the adjustment of the rheostat, the display of light increases to a marvelous extent, and finally a light prickling sensation is experienced in the skin, which becomes painful and is accompanied by tonic contraction of the underlying muscles, if a certain strength of current, variable with each individual, is exceeded. I am studying the effect of the current upon the various divisions of the tactile sense, the sense of taste, the olfactory sense, and the auditory sense, but am not yet prepared to publish my results. The peculiar effects of the current upon the
optic nerve I attribute to its remarkable power of diffusion or penetration.
I have found the current of very great service in connection with the application of large currents for the electrolytic treatment of uterine fibroids, as it greatly lessens the pain of the application, and thus enables the patient to tolerate a current of considerable greater strength than could otherwise be borne. When used for this purpose, an additional electrode is placed upon the back, to which one reopore is attached, the other being connected with the intra-uterine electrode. If after the galvanic current has been made as great as the patient can endure, the magnetic current is turned on, the patient is at once relieved, and the galvanic current may then be increased, usually from to 30 milliamperes. Even when the galvanic current has been increased to such an extent as to lead the patient to beg to have it reduced, the pain usually ceases almost instantly when the sinusoidal current is switched on.
As an analgesic, and for the relief of various illy defined sensations to which persons refer under the general term "pain," I know of no mode of electrical application so valuable as the sinusoidal current obtained from the machine when moving very rapidly, the dose, of course, being regulated by means of a suitable
In a case recently under observation, a patient who had suffered for several years from a peculiar sensation of emptiness in the head, and what she termed a loss of the sense of time, doubtless using this mode of expression for want of a better means of expressing her feelings, complete and permanent relief was obtained by two or three applications. Many patients who seem to have an utter intolerance of any other form of electrical current, are benefited by the application of this current. Indeed, I have never found a case in which any unpleasant effects were produced by it.
The fact that such profound motor and sensory effects can be produced without the ordinary shocking, prickling, and other sensations, is a grateful surprise to the patient, and certainly enhances its value as a therapeutic means.
I have found no electrical application so valuable as a means of relieving a hyperæsthetic condition of the abdominal sympathetic ganglia, especially the semilunary ganglia, the lumbar ganglia, and the lumbo-aortic plexus of the sympathetic. It is equally efficacious in relieving pains beneath the shoulder blade and in the back, which are often erroneously attributed by patients to a diseased liver, but which are due, in a great majority of cases, to a congested and irritated condition of the abdominal sympathetic ganglia.
A rapidly alternating sinusoidal current is one of the most efficacious means with which I am acquainted for the relief of the peculiar sensation known as "heaviness," of which dyspeptic patients often complain. This sensation is due to a perverted condition of the sensory nerves of the stomach. Its relief by a rapidly interrupted current is an evidence of the penetrating power of this current.
The rapidly interrupted current may be applied to the stomach either externally by means of a flat sponge electrode, one over the stomach and the other over the spine opposite, or internally by means of a properly formed electrode placed inside a stomach tube, with a flat sponge electrode either over the stomach or the
spine opposite the stomach. I have applied the sinusoidal current in this manner in a large number of cases for the relief of stomach symptoms, especially in cases in which examination of the stomach fluid by the method of quantitative analysis, which I have elsewhere described, showed deficiency in that form of stomach work which consists in the combination of free chlorine with albumen, as shown by the diminished amount of the combined albumen.
(To be continued.)
THE EFFECTS OF CONDIMENTS UPON STOMACH DIGESTION.
AT the present time a series of very interesting experiments is being conducted in the laboratory, the purpose of which is to determine the effects of condiments
upon peptic digestion. Five healthy young men whose stomach formulæ have been determined by means of the standdard test breakfast, have been made to take in various quantities, with the test breakfast, black pepper, red pepper, pepper sauce, mustard, and other like substances, and the results upon the chemical processes of the stomach have been carefully noted. A very constant and
characteristic effect has been observed in the increase of a certain element of the stomach work, but a notable decrease in another direction. The diminution of stomach work, as will be shown in a more detailed account of these experiments which will be given in a future number, is in the useful work of the stomach, by which the chlorine is made to combine with the albumen; in other words, although condiments of various sorts have the effect to increase the amount of free hydrochloric acid in the gastric juice, and the amount of chlorine liberated from the fixed chlorides, the amount of chlorine which enters into the useful stomach work of digestion is notably diminished.
This method of investigating the effects of various substances upon digestion is one which affords an opportunity for the most useful and extended studies in practical dietetics. A large number of observations of various sorts have already been made in the laboratory, and we hope to be able to give at an early date an extended account of the important data collected, some of which are exceedingly interesting from a practical standpoint as well as from scientific and theoretical considerations.
BATTLE CREEK, MICH., U. S. A., JUNE, 1893.
REPORT OF THREE CASES OF MULTIPLE NEURITIS.
BY W. H. RILEY, M. D. Sanitarium, Battle Creek, Mich.
IT has only been during the past few years that the symptoms of the abovenamed disease have been correctly recognized and diagnosticated, even by neurologists. The symptoms presented had been for many years classified under the heads of "Alcoholic Paralysis," "General Spinal Paralysis," "Locomotor Ataxia," and others; and at the present time in general practice, multiple neuritis is frequently mistaken for some form of spinal trouble, or a very vague and indefinite idea is entertained as to the real nature of the disease, and the correct methods of its treatment. The following three cases are reported,
1. For the purpose of briefly directing attention to some of the prominent symptoms and the course of the above disease. 2. To illustrate successful methods of treatment.
Mr. A., aged 33 years, an American by birth, a laborer by occupation, came to the Sanitarium for treatment of "paralysis of the upper and lower extremities," and gave the following history:
With the exception of slight ailments, the patient had always enjoyed good health up to the beginning of the present trouble. The disease with which he is now suffering began about ten weeks ago, by persistent vomiting, attended with nausea, which continued at short intervals for twenty-four hours. At this time he had a very sore throat, and was obliged to take his bed for one week, with a temperature of 100° to 101° F. While in bed,
his throat continued sore. At the end of one week he was able to be up, but in attempting to walk, noticed a "weakness in the knees." He would tire on the slightest exertion, and walking was an effort. He had a sensation as though the cords and muscles of the legs were getting too short. At times he suffered from a numbness, and burning and aching pains in the feet, which later traveled up the legs. Simultaneously with these symptoms in the feet and legs, were similar manifestations of the disease in the upper extremities. There was a numbness and soreness in the fingers and hands. The fingers felt thick and clumsy, and a weakness, which showed itself most prominently in performing some delicate movement, such as writing or buttoning the clothing, was present. These symptoms continued and grew worse. The patient became weaker, and tired more easily on the slightest exertion. Walking was difficult, and his movements were all weak, incoordinated, and ataxic. At the end of a month the weakness was so great that he could walk no longer, and was obliged once more to take his bed. The pain continued, and increased in severity. The patient remained helpless in bed for several weeks, part of which time he could not move toes or feet. Finally he came to the Sanitarium for treatment, about ten weeks from the beginning of his trouble, and his condition on entrance is indicated in the report of —