December 1,
1871.]
A MIRROR OF HOSPITAL PRACTICE.
HOSPITAL OF 5th N.L.I. A CASE OF MALARIOUS (?) ALBUMINURIA SUCCESSFULLY TREATED.
By J. O'M. McDonnell, M.D., Assistant Surgeon, Bengal Medical Service. Futteh Singh, a sepoy of the 5th Regiment, Native Light Infantry, was admitted into the hospital of this regiment, on the 7th of August, 1871, suffering from the following symptoms:?ascites; general anasarca, both feet and legs being especially oodematous; a feeling of great weakness; partial anorexia; a dull continuous aching pain in the lumbar region, closely resembling that of lumbago ; severe frontal head-aclie of an intermittent character ; slight dyspnoea when standing, but when in the recumbent posture, or when only of exercise was taken, it became very a very moderate amount urgent; skin dry, harsh, flabby and abnormally pale; moderately enlarged spleen ; and scanty urine, only twelve ounces
being voided daily, very pale, slightly alkaline in re-action, of an abnormally low specific gravity, being only 1,001, quite clear when voided, which condition it retained after standing for three hours, without any uric or phosphatic deposits, and when the test for albumen?heat and nitric acid?was employed, it at once became quite opaque. The quantity of urine tested, on standing for a quarter of an hour, was observed to consist of two equally divided portions, the lower consisting of coagulated albumen, the upper of perfectly clear urine. A slight amount of ardor urinre occurred during each micturition. His heart, lungs, alvine evacuations and temperature On several occasions were in a perfectly normal condition. previously, he was received into hospital, suffering either from paroxysms of intermittent fever, of a mild, tertian type, or from some of the symptoms that I have recorded; but wliich latter I did not impute to any renal affection. On all occasions, when in hospital, he invariably complained of a feeling of great prostration, his knees being especially weak, at id of almost complete inefficiency to perform his regimental duties. A plan of treatment was devised, which would give as much rest to the kidneys as possible, by the skin, intestinal canal and liver being stimulated to increased performance of their functions, at the same time that the urine should be Tendered as little acrid as possible, and the healthy condition of the blood be restored. The remedies employed to act upon the liver and bowels were, pills, each of wliich consisted of i grain of elaterium, 2% grains of resin of podophyllin and 2k grains of extract colocynth. comp. During the six days subsequent to his admission into hospital, two of these pills were daily administered, one morning and evening, but invariably two hours before meals ; subsequently only one was given each morning, three hours before breakfast. These pills occasioned daily from four to six copious watery and bilious evacuations, very little tormina and no tenesmust Occasionally I substituted for these pills, the following simple liydra-
gogue cathartic powder p. pulv. jalap, xv gr., potass, acid. tart, xviii ft. pulv. As ginger is considered by many physicians to be a stimulant to the urinary organs, I did not prescribe it in addition to the other ingredients of these powders. Those remedies intended to act upon the skin were, the almost daily employment of the tepid bath; James' and Dover's powders combined, two grains of the former and five grains of the latter in each powder; and a simple alkaline .diaphoretic mixture pi liq. amnion, acet. gii, vin. antimonialis Jss, mist, camphor, ad sviii ft. mist. : gi, ter indies, the administration of which was alternated with that of the powders. Linseed tea, "ad libitum" was given with a view to diminish or remove any acridity which the urine might half a drachm of nitrate of possess. As recovery progressed potash was added to the quantity of linseed infusion lie daily -consumed, in order that it might act as a mild diuretic. With a view to restore the normal condion of the blood, two of the preparations of iron were used, the tincture of the perchloride and the sulphate, fifteen minims of the former or two grains of the latter, in an ounce of infusion of cliiretta, Until the ascitic and anasaras the vehicle, three times daily. cous conditions had subsided, none of the above-mentioned preparations of iron were prescribed for him. Counter-irritation, in the form of a vesicant, was only on one occasion applied to the lumbar regions, to relieve the severe pain lie experienced there, and also with the intention of allaying any ?inflammatory action then taking place in the kidneys. The ?
257
vesicant was applied soon after he had been received into hospital, it most effectually relieved the lumbar pain. Up to the 15th of August, this plan of treatment was attended with very little success, and apprehensions of a fatal issue were recorded, but on this date the patient looked cheerful and was in very good spirits; anasarca had somewhat lessened, though apparently no change had taken place in the ascitic condition of the abdomen, which was as prominent as on the day of admission ; the urine was voided more copiously : its specific gravity had risen to 1003, and the quantity of albumen had to a slight extent diminished. There was also considerable alleviation of all the other symptoms from this date (August 15th) to September 1st, 1871, the date on which all symptoms of the disease had completely subsided. The improvement was very rapid, and quite clearly observable each day, except when he attacked with paroxysms of intermittent fever, six of was which he had while under treatment for the renal disease, the remedies for which had to be discontinued and quinine substituted, fifteen grains of which were administered during the hour that immediately preceded the occurrence of each paroxysm. These febrile attacks, undoubtedly, retarded his recovery, but seemed not to have occasioned any exacerbation of the nephritic affection, as the quantity of albumen in the urine was observed to be neither increased nor diminished immediately prior to the commencement or subsequent to the subsidence of each paroxysm. The specific gravity of the urine gradually increased from 1003 on August 15th to 1011, which it reached on September 1st, 1871, so likewise was there a daily increase of from two to three ounces in the quantity of urine passed, the quantity passed on the 15th August being sixteen ounces, four ounces more than he was accustomed to void daily prior to admission into hospital, and on the 1st September, thirty The albuminous condition of the urine proounces were voided. portionately subsided, until September l'st, when none could be detected ; also on this date its re-action became acid, and the fluid assumed its normal light amber colour. On August 23rd, anasarca and ascites had completely subsided, and on the following day, 24th, all the symptoms not referable directly to the renal affection ceased to exist. On the 7th September, he was discharged to duty quite recovered, feeling, according to his own statement, in far better health than he had been for a very considerable time. In treating this case, the plan of treatment recommended by the chief writers on renal diseases was followed, with the addition that the hepatic functions were especially stimulated by a remedy?podophyllin?which, unlike mercury, though equally as efficacious as a cholagogue, acts solely upon the liver, and which probably materially contributed to the success of the treatment employed. His diet which whilst under treatment consisted of milk and farinaceous articles of food, with which he was plentifully supplied, may also have conduced to his recovery, being at once nutritious and unstimulating. Benaees, September 10th, 1870.
1871.]
A MIRROR OF HOSPITAL PRACTICE.
HOSPITAL OF 5th N.L.I. A CASE OF MALARIOUS (?) ALBUMINURIA SUCCESSFULLY TREATED.
By J. O'M. McDonnell, M.D., Assistant Surgeon, Bengal Medical Service. Futteh Singh, a sepoy of the 5th Regiment, Native Light Infantry, was admitted into the hospital of this regiment, on the 7th of August, 1871, suffering from the following symptoms:?ascites; general anasarca, both feet and legs being especially oodematous; a feeling of great weakness; partial anorexia; a dull continuous aching pain in the lumbar region, closely resembling that of lumbago ; severe frontal head-aclie of an intermittent character ; slight dyspnoea when standing, but when in the recumbent posture, or when only of exercise was taken, it became very a very moderate amount urgent; skin dry, harsh, flabby and abnormally pale; moderately enlarged spleen ; and scanty urine, only twelve ounces
being voided daily, very pale, slightly alkaline in re-action, of an abnormally low specific gravity, being only 1,001, quite clear when voided, which condition it retained after standing for three hours, without any uric or phosphatic deposits, and when the test for albumen?heat and nitric acid?was employed, it at once became quite opaque. The quantity of urine tested, on standing for a quarter of an hour, was observed to consist of two equally divided portions, the lower consisting of coagulated albumen, the upper of perfectly clear urine. A slight amount of ardor urinre occurred during each micturition. His heart, lungs, alvine evacuations and temperature On several occasions were in a perfectly normal condition. previously, he was received into hospital, suffering either from paroxysms of intermittent fever, of a mild, tertian type, or from some of the symptoms that I have recorded; but wliich latter I did not impute to any renal affection. On all occasions, when in hospital, he invariably complained of a feeling of great prostration, his knees being especially weak, at id of almost complete inefficiency to perform his regimental duties. A plan of treatment was devised, which would give as much rest to the kidneys as possible, by the skin, intestinal canal and liver being stimulated to increased performance of their functions, at the same time that the urine should be Tendered as little acrid as possible, and the healthy condition of the blood be restored. The remedies employed to act upon the liver and bowels were, pills, each of wliich consisted of i grain of elaterium, 2% grains of resin of podophyllin and 2k grains of extract colocynth. comp. During the six days subsequent to his admission into hospital, two of these pills were daily administered, one morning and evening, but invariably two hours before meals ; subsequently only one was given each morning, three hours before breakfast. These pills occasioned daily from four to six copious watery and bilious evacuations, very little tormina and no tenesmust Occasionally I substituted for these pills, the following simple liydra-
gogue cathartic powder p. pulv. jalap, xv gr., potass, acid. tart, xviii ft. pulv. As ginger is considered by many physicians to be a stimulant to the urinary organs, I did not prescribe it in addition to the other ingredients of these powders. Those remedies intended to act upon the skin were, the almost daily employment of the tepid bath; James' and Dover's powders combined, two grains of the former and five grains of the latter in each powder; and a simple alkaline .diaphoretic mixture pi liq. amnion, acet. gii, vin. antimonialis Jss, mist, camphor, ad sviii ft. mist. : gi, ter indies, the administration of which was alternated with that of the powders. Linseed tea, "ad libitum" was given with a view to diminish or remove any acridity which the urine might half a drachm of nitrate of possess. As recovery progressed potash was added to the quantity of linseed infusion lie daily -consumed, in order that it might act as a mild diuretic. With a view to restore the normal condion of the blood, two of the preparations of iron were used, the tincture of the perchloride and the sulphate, fifteen minims of the former or two grains of the latter, in an ounce of infusion of cliiretta, Until the ascitic and anasaras the vehicle, three times daily. cous conditions had subsided, none of the above-mentioned preparations of iron were prescribed for him. Counter-irritation, in the form of a vesicant, was only on one occasion applied to the lumbar regions, to relieve the severe pain lie experienced there, and also with the intention of allaying any ?inflammatory action then taking place in the kidneys. The ?
257
vesicant was applied soon after he had been received into hospital, it most effectually relieved the lumbar pain. Up to the 15th of August, this plan of treatment was attended with very little success, and apprehensions of a fatal issue were recorded, but on this date the patient looked cheerful and was in very good spirits; anasarca had somewhat lessened, though apparently no change had taken place in the ascitic condition of the abdomen, which was as prominent as on the day of admission ; the urine was voided more copiously : its specific gravity had risen to 1003, and the quantity of albumen had to a slight extent diminished. There was also considerable alleviation of all the other symptoms from this date (August 15th) to September 1st, 1871, the date on which all symptoms of the disease had completely subsided. The improvement was very rapid, and quite clearly observable each day, except when he attacked with paroxysms of intermittent fever, six of was which he had while under treatment for the renal disease, the remedies for which had to be discontinued and quinine substituted, fifteen grains of which were administered during the hour that immediately preceded the occurrence of each paroxysm. These febrile attacks, undoubtedly, retarded his recovery, but seemed not to have occasioned any exacerbation of the nephritic affection, as the quantity of albumen in the urine was observed to be neither increased nor diminished immediately prior to the commencement or subsequent to the subsidence of each paroxysm. The specific gravity of the urine gradually increased from 1003 on August 15th to 1011, which it reached on September 1st, 1871, so likewise was there a daily increase of from two to three ounces in the quantity of urine passed, the quantity passed on the 15th August being sixteen ounces, four ounces more than he was accustomed to void daily prior to admission into hospital, and on the 1st September, thirty The albuminous condition of the urine proounces were voided. portionately subsided, until September l'st, when none could be detected ; also on this date its re-action became acid, and the fluid assumed its normal light amber colour. On August 23rd, anasarca and ascites had completely subsided, and on the following day, 24th, all the symptoms not referable directly to the renal affection ceased to exist. On the 7th September, he was discharged to duty quite recovered, feeling, according to his own statement, in far better health than he had been for a very considerable time. In treating this case, the plan of treatment recommended by the chief writers on renal diseases was followed, with the addition that the hepatic functions were especially stimulated by a remedy?podophyllin?which, unlike mercury, though equally as efficacious as a cholagogue, acts solely upon the liver, and which probably materially contributed to the success of the treatment employed. His diet which whilst under treatment consisted of milk and farinaceous articles of food, with which he was plentifully supplied, may also have conduced to his recovery, being at once nutritious and unstimulating. Benaees, September 10th, 1870.
