C. C. lumbis ad x. Ant. Pot. Tart. gr. . Mag. Sulph. 38s. Liq. Ammon. Acet. 3ss. ex Mist. Pulv. Ipecac. Comp. gr. v. o. n. 27. Skin still dry: pulse softer: tongue cleaner: pain in the loins much relieved. Aug. dos. Ant. Pot. Tart. ad gr. .-Pergat. 29. Edema much reduced: pulse soft: urine less albuminous: slight perspiration at times. Pulv. Jal. C. sss. ault. auroris. Cont. Mist. sine M.S. et Pulv. ut antea. Sept. 7. The oedema has entirely disappeared, excepting a little about the ancles: the powders have acted very slightly: no albumen in the urine. Pulv. Elaterii, gr. . Pulv. Jalap. C. 9ij. alt. auroris.-Pergat. 12. The last powders have produced rather watery dejections: pulse soft: tongue clean: perspires freely: a little albumen in the urine. Pulv. Elaterii gr. t. Pulv. Jalap. C. 9ij. bis in hebdomadâ. Adde M.S. 3ss. sing. dos. Mist. Cont. Pil. 17. No albumen: no anasarca. 21. Continues well: no albumen. I have ascertaimed that this man is now (seven months since his illness) in good health." The two succeeding cases will be sufficiently explained by their headings, the one being:-anasarca of two weeks' standing-albuminons urine-recovery apparently complete the other,-scarlatina at the age of eight-anasarca, with albuminous urine, at the age of twenty-recovery complete. The following remarks of Dr. Barlow's explain his views: "The three last cases, I think, afford a proof that the disease under consideration does sometimes make its attack, in the adult, in the form of an acute affection, the time of the invasion of which is well marked; and they further shew, that when thus occurring, and when met sufficiently early with decided treatment, it is susceptible of cure. Of this treatment I believe that the use of tartar emetic forms an essential part:-and I take this opportunity of expressing my opinion of its utility, partly with a view of explaining a statement made by Dr. Bright in the Second Volume of this work, that I had believed it to exert almost a specific influence in this disease. This is, perhaps, more than I ever intended deliberately to affirm, as I much doubt the existence of a specific in any disease whatever. But I believe that, in this instance, the tartar emetic is more-it is a remedy suggested by the nature of the affection, and calculated to fulfil the most obvious and important indications, namely, equalizing the circulation, subduing the inflammatory action, and restoring the functions of the skin. At the same time, I am far from recommending its use to the exclusion of other means calculated to aid in fulfilling the same indications: and among the most valuable of these adjuncts, I would reckon moderate local depletion, hydragogue cathartics, the warm bath, or, what is perhaps of equal value when this cannot be employed, the investing the loins in a large linseed-meal poultice. I am aware that a great difference of opinion exists with regard to the diaphoretic plan of treatment in this disease, of which plan the tartar emetic may be regarded as a part; though I am far from ragarding it exclusively in this light; -Dr. Osborne having warmly advocated its use; whilst Dr. Christison says, that it disappointed the expectations which he formed from a perusal of the elegant little treatise of the former; and extols the advantages of diuretics, and seems inclined to regard the apprehensions entertained by many, respecting the ill effects which may be expected from their use, as utterly groundless. But, for my own part, I do not think that sufficient stress has been laid by either of these authors upon the different treatment which must be necessarily required by difference in the period and form (whether acute or chronic) of the disease: for I believe that opposite remedies may be useful in its different stages; just as we know that in bronchitis, a disease which bears no very remote analogy to that under consideration, a decidedly antiphlogistic plan of treatment is imperatively called for in the acute and early stage; but that when the inflammatory action has been subdued, or the disease has passed into the chronic form, stimulating expectorants are frequently of essential service, although their inappropriate or too hasty exhibition is attended with the worst results. Again, it should not be forgotten that copious diaphoresis may occur, either spontaneously or from the effect of remedies, without any concomitant amendment taking place; which happened in the case of Dawkins (case 3 of present communication), and in case 7 of Dr. Bright's communication upon this subject, in the First Volume of this work. But it is not merely as a diaphoretic that I would recommend the tartar emetic in the acute form of this disease: it is on account of its power of lowering the heart's action, as well as its local effects upon the capillaries, when it reaches them through the circulation; whereby it diminishes the inflammation in the superficial capillaries of the lining membrane of tubuli uriniferi: for that such a state of the tubuli exists in the early stage of the disease is, I think, made apparent by the condition of the kidneys, in all the recent cases which have been examined. It may be objected, that there is, not unfrequently, so great an irritability of stomach as to preclude the exhibition of the tartar emetic. This state of stomach has, within my observation, been confined mostly to the more-advanced stages of the disease; for I have only met with it in one recent case, which was complicated with extensive peritonitis, involving the peritoneal coat of the stomach. With regard to the dose of the remedy, I would observe, that where the pulse is hard and full it may be given in such doses as in the first instance to produce nausea; but where there is a low state of the system, the antimony may be given in smaller doses, frequently repeated, so as to reach the capillaries without producing depression. I have never found it necessary to give more than half-a-grain at a dose to an adult; neither have I attempted to push it to the greatest extent possible ;-the object not being to give heroic doses of the remedy, but, if possible, to cure the patient." Setting aside a case in which the albuminous condition of the urine completely disappeared, after two attacks of renal dropsy, we come to the concluding case of Dr. Barlow's, intended to shew, that the plan of treatment recommended above will not be found useless in acute attacks supervening upon the chronic form of the disease, provided a change of measures be adopted as soon as the acute symptoms have subsided; when, as has been already suggested, tonics and moderately stimulating diuretics will be found serviceable. Case.-Albuminous Urine, probably of Two Years' standing—Recent Aggravation-Partial Recovery.-George Sheppard, aged 49, admitted under Dr. Barlow, at the Surrey Dispensary, July 18th, 1839. He said that he had been for two years gradually losing his strength; and during that time he frequently observed his face to be swollen, especially about the eyelids, when he arose in the morning; and that his legs and ancles often swelled: that a year before he had suffered from general dropsy, attended with pain in the loins and across the epigastrium; for which he was admitted as an out-patient at Guy's Hospital, and obtained considerable relief, though the weakness never ceased entirely and that about three weeks ago, he was again, after being wet through, attacked in a similar manner. "At the time I first saw him, his legs, hands, and face, were œdematous, as were the integuments of the loins and abdomen; though I could not ascertain the existence of any fluid in the peritoneal cavity. He complained of aching in the loins, and pain across the epigastrium. His appearance was leucophlegmatic, pulse sharp and frequent, tongue furred, bowels regular. I had not then an opportunity of examining his urine; but having little doubt of the nature of the disease, I ordered him to take one-eighth of a grain of potassio-tartrate of antimony in solution with acetate of ammonia, in camphor mixture, three times daily five grains of Dover's powders every night: and half-a-drachm of compound jalap powder twice a week: to live chiefly on bread and milk. On the 20th, I had an opportunity of examining his urine, which was much loaded with albumen. He was then much relieved, and said he had perspired a little on the preceding night." On the 5th of August, the anasarca had nearly disappeared. He was ordered, Sp. æth. nit. xx. Tinct. ferri sesquichlorid. Mav. ex infus. gentian. comp. t. d. Pulv. ipecac. c. gr. v. o. n. Pulv. jalap. c. 3ss. bis in hebdomadâ. On the 16th of November, he left the dispensary, declaring that he was well, though there was still some albumen in the urine. These communications of Dr. Bright and Dr. Barlow are both interesting, and calculated to direct still more attention, on the part of practitioners, to complaints so serious and so frequent as these renal affections are. ON THE PROPORTION OF UREA IN CERTAIN DISEASED FLUIDS. By G. O. REES, M.D., F.G.S. Physician to the Northern Dispensary. Dr. Rees' object is to determine the proportion of urea contained in the blood in certain morbid states-the existence of it being now established. The following is his plan. "The delicacy of the plan I now adopt is very great; so much so, that urea can be obtained perfectly pure from an animal fluid, which contains it in the proportion only of 0.15 per mille. The analysis is performed as follows:-Te serum, or effused fluid, is evaporated to dryness, at a heat sustained somewhat below 2120 Fahrenheit; the dry mass is broken up; boiling water thrown upon it, and allowed to digest several hours. This liquor being carefully poured off, a second portion of water is added, and allowed to digest; after which, the whole is thrown on a filter, and the solid matters washed with distilled water till the percolating fluid ceases to effect a solution of nitrate of silver. The digested and filtered liquors are next evaporated to dryness, by a gentle heat; and the extract, so obtained, digested in a stopper-bottle, with common ether of the shops, of sp. grav. 0.754. This menstruum extracts the urea only; and by digesting successive portions of it until the last added yields no deposit of that principle on evaporation, we obtain the whole of the urea present, and thus directly estimate its weight. As obtained by this process, urea is quite pure and colourless. It once happened to me to observe some slight contamination of the urea, obtained as above, by fatty matter which had escaped separation with the albumen: this, however, was easily got rid of, by dissolving the urea in distilled water, and throwing the solution on a filter previously moistened, when the fatty matter remained behind, and allowed the urea to pass through, perfectly pure." The following quantities of urea were obtained from different specimens of blood. "The first fluid which I shall mention, as examined by this process, was obtained from John Gillmore, Dec. 18, 1839, a case of albuminuria. It was an effusion on the brain, and 210.4 grs. were obtained for examination. From this quantity 0 05 gr. of urea was obtained, equal to about 0.415 per mille. This fluid yielded but slight traces of albumen. The second case, from which I obtained the serum of the blood, and likewise a portion of fluid which was procured from the cellular tissue by making punctures in the scrotum, was that of John Wiseman, a boy in Job's Ward, under the care of Dr. Bright. The serum of this patient was of sp. gr. 1015, and contained only 23.49 gr. of albumen in 500 grs. ; whereas the same quantity of healthy serum affords about 49.75 grs. It contained 0.2096 per mille of urea. The fluid obtained from the scrotum was of sp. gr. 1007.9; the analysis of 500 parts gave, Water 492.400 0.800 the proportion of urea being equal to 0.150 per mille. The third case, from which I obtained the serum of the blood at two different times, and also the fluid effused into the pericardium, was ing, a patient of Dr. Bright. The first specimen of blood was received on March 4th. of its serum was 1025, being somewhat lower than natural; grs. yielded, Water Extractives and salts that of Susan Small The specific gravity the analysis of 500 452.10 32.50 15.15 0.25 500.00 We here observe a deficiency of albumen an increase of extractives and salts, and the presence of an ingredient foreign to the serum. The second specimen of blood which I received from this patient was obtained by cupping; and not from the arm, as was the case with all the previously mentioned specimens. It was sent to me on the 30th of April. The specific gravity of its serum was then 1029, or natural; the analysis of 500 parts was as follows: Water 448.3 40.8 10.65 0.25 500.00 The effusion into the pericardium of this patient was of sp. grav. 1028. It yielded urea, but only a trace in 500 grs. of the effusion. It will be observed, from the analysis quoted above, that the largest proportion of urea which I have detected in the blood is 0.5 per mille, and the least 0.2096. The effusion on the brain gave 0.415; the fluid effused into the cellular tissue of the scrotum, 0.150 per mille; and the pericardial fluid merely a trace in 500 grains. The condition of the blood in the patient Susan Smalling is worthy of consideration, inasmuch as the serum of the blood underwent a great change between the dates of March 4th and April 30th it being sp. grav. 1025 on the former, and 1029 sp. grav. on the latter date the proportion of urea, however, remaining the same. The serum of the 30th of April, if we except the existence of urea, may be considered as normal; the albumen being present quite to the natural extent; indeed, if any thing, somewhat beyond the amount generally found in the serum of healthy blood. The case from which the scrotal fluid was obtained, affords an instance of great decrease in the specific gravity of the serum of the blood. The lowest specific gravity mentioned by Dr. Christison, in his lately-published valuable work, is 1019; this specimen was, however, only 1015 sp. gr." Dr. Reese has been unable to obtain urea from the serum of healthy blood. OBSERVATIONS ON THE EXISTENCE OF CERTAIN ELEMENTS OF THE MILK IN THE URINE DURING UTERO-GESTATION; AND ON THE APPLICATION OF THIS FACT TO THE DIAGNOSIS OF PREGNANCY. By GOLDING BIRD, M.D. F.L.S. &c. This indefatigable and talented young physician, had his attention drawn by the Medical Journals to a peculiar mucilaginous principle, said to exist in the urine of pregnant women. This new constituent, he says, of the renal secretion, which has been dignified with the name of Kiestien, is stated to exist in the urine of the human female during utero-gestation, and to become visible when the secretion is allowed to repose in a cylindrical vessel, in the form of a cottonlike cloud, which in a lapse of time, varying from the second to the sixth day of exposure, becomes resolved into a number of minute opaque bodies, which rise to the surface, forming a fat-like scum, which remains permanent for three or four days; the urine then becomes turbid, and minute flocculi detach themselves from the crust, and sink to the bottom of the vessel; this action continues until the whole pellicle disappears. This crust of Kiestein is stated to be distinguishable from analogous pellicles which occasionally form on the surface of urine, from its never becoming mouldy, or remaining on the surface beyond three or four days from the time of its complete formation. Dr. Bird accordingly examined the urine first passed in the morning by about thirty pregnant women, and, in all, save three, copious fat-like pellicles were observed on it, after two or three day's exposure. The next thing Dr. Bird did, was to examine the nature of this Kiestien. "None of the specimens of urine voided by pregnant women, that I have examined, were coagulable by heat, nitric acid, or, with but two or three exceptions, by acetic acid, and therefore could not contain any considerable portion of albuminous or caseous matter; the addition of ammonia almost invariably produced a dense deposit of earthy phosphates; which, under the microscope, appeared to consist of myriads of minute acicular crystals; and, with the exception of this proof of the existence of an excess of earthy phosphates in the secretion, no appreciable portion of any anormal ingredients could be detected. Some of the fat-like pellicle was removed from the surface of some urine on which it had formed, by plunging a plate of glass perpendicularly into the fluid, and withdrawing it adroitly, in a nearly horizontal position; an equable layer of the substance was thus procured; and, when carefully covered with another plate of glass, it could be very conveniently submitted to examination. The pellicle thus procured, appeared glistening with a lustre like that of spermaceti; when placed under a microscope, and examined with an objectglass of a quarter-inch focal length, myriads of superb triangular prisms, strongly refracting light, and resolving it into colours, were seen imbedded in a mass of irregular granular matter, mixed with which, might here and there be seen patches of tolerably regular globular bodies. The transparent trian |