OSMOSIS THROUGH THE SKIN.
ry
/ V/
DWARKA PRASAD BHARGAVA, m.b., b.s., Karwi, Bancia.
know if there is any literature on the and this is my excuse for publishing the results of a few observations made on the subject during the treatment of certain diseases. On the 2nd September, 1916, a patient was brought to the hospital 'with general anasarca. The case was diagnosed as one of Bright's disease. He was given the usual treatment of purgatives without effect. The, tension of the fluid in the skin was very great, so much so that fluid appeared to be on the point of bursting through the skin of some parts of the body, such This as the scrotum and about the ankle joint. tension of the fluid in the skin suggested to me This was osmosis as a means of treatment. The carried out by hypertonic saline baths. brief history of the case and its progress is as follows :? The patient was a boy of 14, duration of swelling one month. The accumulation of the fluid in the skin was very great. The puffy eyelids almost obstructed the vision. There was hydrothorax and ascites. The swelling of the thighs and scrotum prevented the patient from walking. Urine, which was scanty, showed on boiling a thick cloud of albumen, filling half the length of the urine in the test tube. For the first three days the patient was given magnesium sulphate I
do not
subject,
and tincture digitalis with no effect. From the 5th September, 1916, saline baths at the bodytemperature (dr. ii to a pint) were given for two hours twice a day. The patient was put on milk diet and given tinct. ferri. perchlor., all other medicines were stopped. By the 8th September, there was marked reduction of the anasarca over the knees, and the skin at many places became wrinkled. On the 9th September, the patient developed erysipelas in the right leg, which subsided by the 14th September. The baths were continued all along and the anasarca and the ascites were reducing. On the 16th September, the patient developed dysentery (the usual scanty stools of mucous and fsecal matter and not copious watery discharges) which continued more or less till the patient left the hospital. By the 18th September, the anasarca had subsided, with the exception of a little puffiness of the eyelids and swelling of the feet. Urine, on boiling, showed no precipitate, but only a cloudiness. There were a few tube-casts and the urine was free. From 19th to 23rd, when the baths were altogether stopped, the patient was given a bath only once a day, owing to the cloudy weather. The patient left the hospital on the 26th September, when all anasarca and ascites had disappeared, a slight puffiness of the eyelids and oedema of the feet still remaining. Examination of the urine showed no tube-casts but just a little milkiness on boiling. Nitric acid test was negative. Urine was quite free. It is interesting to note that, with the subsidence of the anasarca, there was a reduction in the quantity of albumin and an increase in the flow of urine. The patient reported at the hospital on the 21st October, 1916. He was still anaemic, with slight puffiness of the face, and no oedema of the feet. Urine was free; albumin, just a cloud, He reported again on the but no tube-casts. 10th December, 1916. Albumin the same as the The last time; no tube-casts and no oedema. refused to underon both the occasions, patient, go a further course, of treatment. At about the same time when the above case was being treated, a patient, who used to attend the outdoor for abscesses in the right elephantoid leg, was admitted in the hospital on the 21st September, 1916, and saline baths tried on him. The patient, an adult male of 45, had the disease On admission, he had three for three years. sinuses which were almost healed up. The leg he had to crawl. was too heavy for him and He was given saline baths, the strength of which were gradually increased from 3 drachms to the pint up to 2 ounces and 3 drachms to the pint. From 23rd September to 17th November, 1916, the treatment was almost continuous, with a few interruptions when, owing to fever, baths could not be given. The leg used to swell up after every bath until the strength was increased to and dr. iii to pint 1. The oedema then oz. ii
Sept., 1921.]
OSMOSIS THROUGH THE SKIN: BHARGAVA.
decreased gradually and the hard < edema became soft. The skin round scar tissue of the healed sinuses made slow progress. The measurements of the legs 011 admission, discharge, and a few days after discharge are given below :? Ct
r.'S
2 5 c z Ci
rO
e o
honour to be at the K. Lucknow, that if I got
329 G.
Medical College, with oedema of hoth limbs, I should subject one limb only to this process and note results. Since then many experiments on this line have been tried on cedematous legs of cases of Bright's disease and an semi a with similar results. Some of them are given below :? a
case
Case No. J.
II cd
Ft Sound leg (lefi) Diseased leg on admission (21 9 16) Diseased leg on discharge
(17-11-16) Diseased leg
1
.
on
12-12-16
Difference of measurement between ad 111 is sion and discharge
The progress
1
In ft. In. 1 11 1 3
t
11.} I 1" 1
3A
1
1H r
U
34
was
diet. about the time when I was treating case No. 2 that it was suggested to me by Major Megaw, 1.M.S., whose pupil I have had the It
was
Left leg in well water.
tion.
Difference.
2:13
2
marked since the strength of saline was increased to oz. ii and dr. iii to pint 1. It may be noted that though the osmotic treatment did not cure the disease, yet it relieved the patient a good deal. Another patient, an adult male of 35 years, was admitted on the 27th January, 1917, for general anasarca. The anasarca followed twenty days after an attack of fever (possibly malarial), in October, 1913. The swelling went down a month after the onset by treatment, but appeared again in February, 1914, and since then'it never went down completely. Examination of urine showed albumin two-thirds of urine in the test tube and numerous tube-casts of a hyaline nature. From 28th January to 12th February, 1917, the various experiments of the nature mentioned hereafter were tried and at least one leg was dipped in saline solution of various strengths. The swelling of the face and neck, after sleep, diminished which used to occur gradually and the oedema, on the whole, decreased. Urine increased from 28 to 48 ounces and it was a little clearer and the albumin decreased from two-thirds of urine in the test tube to one-fourth. The tube-casts also diminished in number. From the 12th February to 6th March, the patient was given saline baths of 1 in 20. A further increase in the flow of urine the up to 77 ounces gradually occurred, and ("edema gradually disappeared, with the exception of slight puffiness of the face and a little swelling of the legs. There were no tube-casts, and albumin was just a trace. From the 6th to the 26th March, when the patient was discharged, he had no baths except occasional dipping of one leg in saline f01\ experimental purposes. During this period urine decreased from 77 to 50 ozs., albumin only a trace, no tubecasts. and 110 cedema of any part of the body. The patient was all along on his ordinary Indian
village
Right kg in saline solu-
l(,t. In.[ l-'t. In. 9 84
inches below tubercle of tibia. 6 inches below tubercle of tibia. At level of mid-tarsal 3
joint.
At level of heads of metatarsals.
Ins. 114
?
Ins.
Ins.
Ins.
Hi
11J
11J
10
9J 10 10
10
|
10
9.1
91
i
Ins. +1
10}
-1
105
0
+} '
1
10
The patient was made to sit on the ground to minimise the action of gravity, but still, as the above table shows, there was increase in the dimensions of the left leg placed in simple water. The left leg was originally the less swollen of the two. The cause of oedema in the patient The strength of the saline used was anaemia. in this experiment was 1 in 20. Case No. II. Right in
I,eft in saline.
Ins.
inches below tubertibia. 8 inches below tubercle of tibia. 11 inches below tubercle of tibia. At level of mid-tarsal
4
io!
Ins.
l
ry
/ V/
DWARKA PRASAD BHARGAVA, m.b., b.s., Karwi, Bancia.
know if there is any literature on the and this is my excuse for publishing the results of a few observations made on the subject during the treatment of certain diseases. On the 2nd September, 1916, a patient was brought to the hospital 'with general anasarca. The case was diagnosed as one of Bright's disease. He was given the usual treatment of purgatives without effect. The, tension of the fluid in the skin was very great, so much so that fluid appeared to be on the point of bursting through the skin of some parts of the body, such This as the scrotum and about the ankle joint. tension of the fluid in the skin suggested to me This was osmosis as a means of treatment. The carried out by hypertonic saline baths. brief history of the case and its progress is as follows :? The patient was a boy of 14, duration of swelling one month. The accumulation of the fluid in the skin was very great. The puffy eyelids almost obstructed the vision. There was hydrothorax and ascites. The swelling of the thighs and scrotum prevented the patient from walking. Urine, which was scanty, showed on boiling a thick cloud of albumen, filling half the length of the urine in the test tube. For the first three days the patient was given magnesium sulphate I
do not
subject,
and tincture digitalis with no effect. From the 5th September, 1916, saline baths at the bodytemperature (dr. ii to a pint) were given for two hours twice a day. The patient was put on milk diet and given tinct. ferri. perchlor., all other medicines were stopped. By the 8th September, there was marked reduction of the anasarca over the knees, and the skin at many places became wrinkled. On the 9th September, the patient developed erysipelas in the right leg, which subsided by the 14th September. The baths were continued all along and the anasarca and the ascites were reducing. On the 16th September, the patient developed dysentery (the usual scanty stools of mucous and fsecal matter and not copious watery discharges) which continued more or less till the patient left the hospital. By the 18th September, the anasarca had subsided, with the exception of a little puffiness of the eyelids and swelling of the feet. Urine, on boiling, showed no precipitate, but only a cloudiness. There were a few tube-casts and the urine was free. From 19th to 23rd, when the baths were altogether stopped, the patient was given a bath only once a day, owing to the cloudy weather. The patient left the hospital on the 26th September, when all anasarca and ascites had disappeared, a slight puffiness of the eyelids and oedema of the feet still remaining. Examination of the urine showed no tube-casts but just a little milkiness on boiling. Nitric acid test was negative. Urine was quite free. It is interesting to note that, with the subsidence of the anasarca, there was a reduction in the quantity of albumin and an increase in the flow of urine. The patient reported at the hospital on the 21st October, 1916. He was still anaemic, with slight puffiness of the face, and no oedema of the feet. Urine was free; albumin, just a cloud, He reported again on the but no tube-casts. 10th December, 1916. Albumin the same as the The last time; no tube-casts and no oedema. refused to underon both the occasions, patient, go a further course, of treatment. At about the same time when the above case was being treated, a patient, who used to attend the outdoor for abscesses in the right elephantoid leg, was admitted in the hospital on the 21st September, 1916, and saline baths tried on him. The patient, an adult male of 45, had the disease On admission, he had three for three years. sinuses which were almost healed up. The leg he had to crawl. was too heavy for him and He was given saline baths, the strength of which were gradually increased from 3 drachms to the pint up to 2 ounces and 3 drachms to the pint. From 23rd September to 17th November, 1916, the treatment was almost continuous, with a few interruptions when, owing to fever, baths could not be given. The leg used to swell up after every bath until the strength was increased to and dr. iii to pint 1. The oedema then oz. ii
Sept., 1921.]
OSMOSIS THROUGH THE SKIN: BHARGAVA.
decreased gradually and the hard < edema became soft. The skin round scar tissue of the healed sinuses made slow progress. The measurements of the legs 011 admission, discharge, and a few days after discharge are given below :? Ct
r.'S
2 5 c z Ci
rO
e o
honour to be at the K. Lucknow, that if I got
329 G.
Medical College, with oedema of hoth limbs, I should subject one limb only to this process and note results. Since then many experiments on this line have been tried on cedematous legs of cases of Bright's disease and an semi a with similar results. Some of them are given below :? a
case
Case No. J.
II cd
Ft Sound leg (lefi) Diseased leg on admission (21 9 16) Diseased leg on discharge
(17-11-16) Diseased leg
1
.
on
12-12-16
Difference of measurement between ad 111 is sion and discharge
The progress
1
In ft. In. 1 11 1 3
t
11.} I 1" 1
3A
1
1H r
U
34
was
diet. about the time when I was treating case No. 2 that it was suggested to me by Major Megaw, 1.M.S., whose pupil I have had the It
was
Left leg in well water.
tion.
Difference.
2:13
2
marked since the strength of saline was increased to oz. ii and dr. iii to pint 1. It may be noted that though the osmotic treatment did not cure the disease, yet it relieved the patient a good deal. Another patient, an adult male of 35 years, was admitted on the 27th January, 1917, for general anasarca. The anasarca followed twenty days after an attack of fever (possibly malarial), in October, 1913. The swelling went down a month after the onset by treatment, but appeared again in February, 1914, and since then'it never went down completely. Examination of urine showed albumin two-thirds of urine in the test tube and numerous tube-casts of a hyaline nature. From 28th January to 12th February, 1917, the various experiments of the nature mentioned hereafter were tried and at least one leg was dipped in saline solution of various strengths. The swelling of the face and neck, after sleep, diminished which used to occur gradually and the oedema, on the whole, decreased. Urine increased from 28 to 48 ounces and it was a little clearer and the albumin decreased from two-thirds of urine in the test tube to one-fourth. The tube-casts also diminished in number. From the 12th February to 6th March, the patient was given saline baths of 1 in 20. A further increase in the flow of urine the up to 77 ounces gradually occurred, and ("edema gradually disappeared, with the exception of slight puffiness of the face and a little swelling of the legs. There were no tube-casts, and albumin was just a trace. From the 6th to the 26th March, when the patient was discharged, he had no baths except occasional dipping of one leg in saline f01\ experimental purposes. During this period urine decreased from 77 to 50 ozs., albumin only a trace, no tubecasts. and 110 cedema of any part of the body. The patient was all along on his ordinary Indian
village
Right kg in saline solu-
l(,t. In.[ l-'t. In. 9 84
inches below tubercle of tibia. 6 inches below tubercle of tibia. At level of mid-tarsal 3
joint.
At level of heads of metatarsals.
Ins. 114
?
Ins.
Ins.
Ins.
Hi
11J
11J
10
9J 10 10
10
|
10
9.1
91
i
Ins. +1
10}
-1
105
0
+} '
1
10
The patient was made to sit on the ground to minimise the action of gravity, but still, as the above table shows, there was increase in the dimensions of the left leg placed in simple water. The left leg was originally the less swollen of the two. The cause of oedema in the patient The strength of the saline used was anaemia. in this experiment was 1 in 20. Case No. II. Right in
I,eft in saline.
Ins.
inches below tubertibia. 8 inches below tubercle of tibia. 11 inches below tubercle of tibia. At level of mid-tarsal
4
io!
Ins.
l
