PERIODIC HCEMATURIA. By C. It. Fbancis, M.B.
subject of "periodic hcematuria" has been recently much by the profession in England ; and a valuable communication was contributed by Dr. Lionel Beale in the August number of the Practitioner, which he concludes by saying, "perhaps the disease is, after all, mure closely allied to ague The
discussed
than to any affection of which hosmaturia is a symptom." Dr. Beale, I venture to think, has detected the true indication of this discharge. Practitioners have been so accustomed to regard diaphoresis as the ordinary and only termination to an attack of ague, that
they are not prepared to recognize any other as critical. Surgeon D. F. Rennie, H.M's British Forces, when in medical charge of the English and French legations in China in 1862, submitted to the senior medical officer some original views on the nature of discharges other than diaphoretic in connection with intermittent fever. The gist of his views amounted to this : that transmission to the intestinal tract and other parts was fresubstituted, in this disease, for the
quently
Dr. Eennie was, for the General efficiency of
Hospital
time, engaged Calcutta, with a
some
in
in
sweating stage.
experimenting
view to
testing
at
the
" tartar emetic ointment" as a remedial agent in every disease. In this somewhat crotchetty idea, he was not borne out by facts ; but his views on the subject of vicarious discharges in periodic fever are of attention.
nearly
worthy
THE INDIAN MEDICAL GAZETTE.
278 in attacks of
is not
uncommonly observed explanation of their nature is, in many instances, correct. He wisely advises practitioners not to be led away by the local affection into a misconception of the true state of the case. It may, indeed, be necessary to moderate or control the diarrhoea, but the staple of treatment should be quinine. Several medical officers, who were serving with Dr. Rennie, were inoculated with his views. The malarious nature of some forms of diarrhoea and dysentery where the discharges are periodic?quite independent of attacks in which the purging represents the diaphoresis?are well known to practitioners in tropical climates ; and such cases do not do well unless, in addition to local treatment, ante-periodics are given.
Periodicity
in malarious
In Dr. Beale's case
purging
and
districts;
doubtless Dr. Rennie's
the attacks were
remarkably periodic
>
and the account given of them points to an evidently malarious origin. The discharge was not hematuria, in the true of the word, (there were no blood corpuscles,) but a form of albumen with mucus, and an abundance of urates. Dr. Rennie has gone so far as to say that he believes an effusion, which would be albuminous, may take place into the pleura or any other aerous sac at the close of an attack of ague, instead of the usual diaphoresis. The character of the discharge in Dr. Beale's
sense
and other
cases
would be
quite in keeping with these
views.
It is
very clear however whether, in the cases referred to, there were conditions corresponding to the three stages of a periodic febrile attack with the so-called hoematuria as the most prominent of
not
the three, dependent
whether this last was
simply a cyclical condition, origin, and tending to become a habit. tropical climate, the Protoean consequences of malarious infection are familiar enough ; and it is more than probable that an Indian physician would at once have recognized, as Dr. Beale ultimately did, in the cases which form the subject of these remarks, a genuine malarious or
upon a malarious To us, who live in a
disorder.
[December 1,
1868.
subject of "periodic hcematuria" has been recently much by the profession in England ; and a valuable communication was contributed by Dr. Lionel Beale in the August number of the Practitioner, which he concludes by saying, "perhaps the disease is, after all, mure closely allied to ague The
discussed
than to any affection of which hosmaturia is a symptom." Dr. Beale, I venture to think, has detected the true indication of this discharge. Practitioners have been so accustomed to regard diaphoresis as the ordinary and only termination to an attack of ague, that
they are not prepared to recognize any other as critical. Surgeon D. F. Rennie, H.M's British Forces, when in medical charge of the English and French legations in China in 1862, submitted to the senior medical officer some original views on the nature of discharges other than diaphoretic in connection with intermittent fever. The gist of his views amounted to this : that transmission to the intestinal tract and other parts was fresubstituted, in this disease, for the
quently
Dr. Eennie was, for the General efficiency of
Hospital
time, engaged Calcutta, with a
some
in
in
sweating stage.
experimenting
view to
testing
at
the
" tartar emetic ointment" as a remedial agent in every disease. In this somewhat crotchetty idea, he was not borne out by facts ; but his views on the subject of vicarious discharges in periodic fever are of attention.
nearly
worthy
THE INDIAN MEDICAL GAZETTE.
278 in attacks of
is not
uncommonly observed explanation of their nature is, in many instances, correct. He wisely advises practitioners not to be led away by the local affection into a misconception of the true state of the case. It may, indeed, be necessary to moderate or control the diarrhoea, but the staple of treatment should be quinine. Several medical officers, who were serving with Dr. Rennie, were inoculated with his views. The malarious nature of some forms of diarrhoea and dysentery where the discharges are periodic?quite independent of attacks in which the purging represents the diaphoresis?are well known to practitioners in tropical climates ; and such cases do not do well unless, in addition to local treatment, ante-periodics are given.
Periodicity
in malarious
In Dr. Beale's case
purging
and
districts;
doubtless Dr. Rennie's
the attacks were
remarkably periodic
>
and the account given of them points to an evidently malarious origin. The discharge was not hematuria, in the true of the word, (there were no blood corpuscles,) but a form of albumen with mucus, and an abundance of urates. Dr. Rennie has gone so far as to say that he believes an effusion, which would be albuminous, may take place into the pleura or any other aerous sac at the close of an attack of ague, instead of the usual diaphoresis. The character of the discharge in Dr. Beale's
sense
and other
cases
would be
quite in keeping with these
views.
It is
very clear however whether, in the cases referred to, there were conditions corresponding to the three stages of a periodic febrile attack with the so-called hoematuria as the most prominent of
not
the three, dependent
whether this last was
simply a cyclical condition, origin, and tending to become a habit. tropical climate, the Protoean consequences of malarious infection are familiar enough ; and it is more than probable that an Indian physician would at once have recognized, as Dr. Beale ultimately did, in the cases which form the subject of these remarks, a genuine malarious or
upon a malarious To us, who live in a
disorder.
[December 1,
1868.
