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what he has gained by an early operation, by osmosis into these channels and into the and what he and his patient have escaped by pelvis of the kidney, where it is carried by not waiting for late one.

The ureters to the bladder.

These arterioles have the muscular coat discarded when they enter the kidneys, but

their fibrous coat furnishes the connective CHRONIC NEPHRITIS IN THE AGED.* tissue stroma of the kidney.

When the blood absorbs irritant proteid ferJ. PALMER MATTHEWS, M. D.

ments from the alimentary canal and filters them through the kidneys there is produced

a diapedesis of white blood cells through the In the examination of the old soldiers who

irritated capillaries and a new formation of come before the pension board I frequently connective tissue in the fibrous coat. This find three marked symptoms of degeneration

process continues all over the body with which when taken together are diagncstio of hardening of the tissues of the liver, brain, chronic interstitial nephritis.

kidneys and all organs well supplied with The hardened arteries, hypertrophied beart, arterioles; altered blood supply produces and insufficiency of the kidneys, are sequelae amaurosis and congestions with loss of funcin a chain of symptoms which start from a

tions to these vital organs. faulty metabolism of animal proteids in the

The heart hypertrophies to compensate for process of digestion, causing the formation

the resistance increasing in the narrowed of poisonous leucomaines, and the absorption

brittle arterioles. The strong, full pulse of into the blood of unoxidized nitrogenous by.

a sclerosed artery is a diagnostic sign. If products.

the condition is not remedied by glenoin, The arterioles become spasmodically con

aconite or other arterial sedatives, apoplexy tracted, causing resistance in the circulation to the action of the heart which becomes by- and cause blood stasis and general anasarca.

may suddenly end all, or the heart will weaken pertrophied to compensate for the added work.

These proteid substances bave the same Diagnosis.- Differential between intersti. formula of N,1.00 urea, except that they tial and parenchymatous becomes clear when are unoxidized. They are urio acid NH. we see by the microscope that in the latter C,0, from nuclein cells and creatin NH there is a proliferation of the epithelial cells C.0,+H2O from muscle. The formula of of the uriniferous tubules, plugging them up nuolein is C2,84,N,022P,

with epithelial casts, causing soanty urine In the process of digestion of meats the and large, wbite kidney from thickening of nuclein of the animal cells is oxidized into the uriniferous tubules in the parenchyma urea for excretion from the blood by the of the kidney. In the former, interstitial kidneys. The lirer and small intestines are connective tissue from the outer coat of the the places where this oxidation takes place. blood vessels, does not stop the secretion of If they are inactive the poisonous by-products water, but shrinks up the malphigian blood are retained to the detriment of the whole tufts from which is secreted the solid con. conomy, and are not properly eliminated as stituents of the urine. So we have copious urea, but circulate as forms of uric acid and flow of urine with retention of solids in the creatin.

blood; and a contracted kidney with adherent Acute dysentery or a lithemic attack may capsule from fibrous inflammation. be the beginning of the absorption of pro- The presence of casts in the urine of par. ducts of putrefaction and progressive inflam- epchymatous nephritis is diagnostio of the mation of the liver and kidneys, causing cir. chronic or acute stage. When the casts are rhosis and interstitial nephritis.

epithelial they indicate an acute proliferation The symptoms are persistent headache, diz- of cells in the uriniferous tubules. When the ziness, dull memory, nervous flusbes and casts are hyaline they indicate a chronic degeneral uremic symptoms with a copious flow generative process wbich follows the subsi. of pale, urine of low specifio gravity and dence of the acute stage. strong, slow pulse.

The presence of albumen in the urine of The histology of the kidney shows us mal. interstitial nephritis indicates a progressive pighian tufts of blood vessels from which is inflammation with diapedesis of white blood secreted the solid constituents of the urine. corpuscles through the diseased capillary A large supply of blood passes through arteri. walls to form new connective tissue from the oles, which are in contact with the urinifer. fibrous coats of the arteries. ous tubules. The water of the blood passes

When the albumen is diminished or absent

the inflammatory process is in abeyance and * Read before the Western District Medical Society at

the disease is chronio.

Alton, October 27. 1905.


Interstitial nephritis is a degeneration frequently found in the aged, or those prematurely aged from disease.

The treatment of these symptoms of func- Issued Tenth and Twenty-Fifth of Every Month. tional impairment of organs so vital is rest.

Under the Editorial Direction of The insufficiency of the liver and kidneys


THOS. A. HOPKINS, should be relieved by careful regulation of

CARL E. BLACK. the diet and exclusion of the proteids of the

With the following staff of Department Editors animal kingdom. These are known to form -- 0. E. LADEMANN, Internal Medicine.

JOHN MCHALE DEAN, Surgery. poisons when not sufficiently oxidized by

R. B. H. GRADWOHL, Pathology and Bacteriology. the liver.

W. H. VOGT, Obstetrics and Gynecology,

WALDEMAR FISCHER, Ophthalmology. The eminent scientist, Mechkinott, of the A. LEVY, Pediatrics.

W. T. HIRSCHI, Therapeutics. Pasteur Institute, Paris, France, has found

A. F. KOETTER, Otology. a cure for old age. He says man is as old as HERMAN STOLTE, Laryngology and Rhinology.

F. P. NORBURY, Nervous and Mental Diseases. his arteries. He recognized that the absurp- T. A. HOPKINS, Genito-Urinary Diseases.

ROBERT H. DAVIS, Dermatology. tion of products of proteid metabolism, decomposed in the alimentary canal was the cause of the degeneration of his arteries when circulating in the blood. He has found lac

EDITORIAL tic acid to be an efficient destroyer of patho. genio germs By a process of yeast fermentation be prepares milk in the form of kumiss It is imperative in this day of concerted ef. to predigest the proteid of casein sufficient fort in almost every line of business activity, for his bodily nourishment. The lactio acid

for medical men to keeps the alimentary canal free from ptomain The

pause and consider the poisons.

Independent tendency of the times in Professor Neiswanger of the Chicago Medical Press. their own individual School of Electro-Therapeutics, has made the

field, which while strict. happy experiment of placing his nephritic ly and essentially professional, must necespatients on an insulated chair and giving sarily have in it some consideration of the them an electric batb from a statio machine.

commercial, Under this treatment the blood pressure sub

In this prelude we refer to medical joursides, and the albumen disappears from the

nalism, which in its varied phases, presents urine.

one at this time, which we believe is not to When we recognize high blood pressure

the best interests of the profession as a whole. with slow, full pulse and exaggerated second

We refer to the tendency in certain quarters sound of an hypertropbied heart, with other

to give to those medical journals, the propevidences of uremio poisoning in our patients erty of State or National organizations, a rec

a who are advanced in age we should warn them

ognition beyond that of the independent med. in time. Stop their meat and coffee, and call

ical press. their attention to the proteid foods of the Medical journalism should be democratio; vegetable kingdom, which are so scientifi.

should be governed only by the broud princally prepared, such as toasted wheat flakes ciples of democracy and not bampered or of the Battle Creek Sanitarium.

circumscribed by "expediency" or "the fear of consequences.

Every editor should be broad enough, and AFTER removal of the appendix symptoms

so full of the desire to approach the ideal

of truth, that he can serve the interests of of appendicitis sometimes persist, leading the patient to believe that the organ had not

the profession as a whole, and consequently been extirpated. These are generally due

without prejudice or partiality. to a colitis, which must be treated by high

There is a place for such an editor, whether

be edit a small journal, or one of larger cali. irrigations, diet, eto.

ber, and in him should be vested the eternal TREATMENT OF BUBO.-Orville Horwitz di- rights of liberty and the pursuit of happirects to shave and sterilize the overlying ness, for the profession which he represents. skin; punoture and evacuate pus with a bis. No one editor knows all of the needs of the toury; irrigate cavity with hydrogen peroxide profession; he of the larger journal is cosmo

; till washings are clear, then with 1:5000 bi. politan in all of his aims, and perbaps he of obloride solution. Next ill cavity with ten the small journal is more or less provincial, per cent iodoform in vaseline, apply a piece but both should aim only at truth-live up of ice over the part till the vaseline is hard- to it, fight for it, and convince his respective ened, and dress with a firm compress of gauze.

readers that it is only right living, right


practices, which hold our profession together This disease presents many practioal ques. and make medicine a noble calling.

tions which are of especial importance to the When we lose sight of ideals we fall into

physician. By tbe time the way of error, whioh leads to the undoing

they come to the sur

Cancer of of professionalism, unmakes brotherhood

the Breast.

geon they are already and leaves a dark brown taste in the mouth.

convinced in their own The independent medical press is free to

minds that an operation move, free to speak and free to serve, and will be required. The physician should deshould stand for its own and make for it. vise some plan of education by which the self the place it deserves the leader of woman with the "lump" in the breast will medical thought and the believer in an op- place herself under early observation. The timism which should make the profession dreadful , results, of late, operations have grander and better.

driven the women to secrecy or to the quack. It is said that one of the prime charac- It is for the general practitioner to lead them teristics of the men of culture is bis freedom

baok to rational understanding of the benefrom provincialism, his complete deliverance fits of an early operation. No one knows from rigidity of temper, narrowness of inter- fully what the benefit of early operations est, uncertainty of taste and general unripe would be. There bave been too few oppor

We think tbis quotation applicable as tunities for such operations to give us as yet evidence in forming judgment of an ideal in. reliable statistics. We do know in general dependent medical press. The greater the that the results are infinitely better than culture shown in its policies, the greater its those operated late after metastases have usefulness, because it creates authority, taken place and the disease is beyond raises standards, broadens experience, and the reach of any kind of operation or treatapproaches near to the ideal in truth and

ment yet devised. More than 80% of all tu. purpose.

mors appearing in the breast are cancerous. Now one of the greater dangers of a state Of these all will have metastatic recurrence if journal, in its editorial work is in its ten- allowed to develop. These extensions will be dency to be governed by isolated policies, in the glands of the axilla and neck and rewhich, alas! may not be for the benefit of

mote parts; in the thorax; in the abdomen; the profession as a whole, for we know that in the brain; in the spine; in the bones. medicine as a profession is full of provincial. Every such “lump' should be examined at ism and is always substituting a part for the once, and if there is the least possible doubt, whole, much to tbe detriment of a broad, wide it should be removed and a careful microexperience so necessary to the development scopical examination made. If this speciof progressive reforms. A long experience, men is not unquestionably benign, the as we all know, counts in the weight or esti. breast and axillary and clavicular glands mation of the balance of usefulness and equi. with their contiguous fascia and muscle, poise of a man, and why should we not apply should be removed thoroughly and comthe same measure to the organization as a

pletely. In advising such a patient we must whole, especially to medical societies. If we keep in mind the terminal stages of these do this it is to be expected that the indepen. cases and often present them plainly and dent cultured press of years of experience fully to the patient and family. No operawill draw a fairly rational, conservative view

tion with any amount of loss of function of of the needs of the profession, recognize the arm or side can compare for a moment the value of its creeds and help in develop with the terrible ordeal through which many ing wise and true policies for the good of of these victims pass. An early, radical opthe profession.

eration, as now performed, will lessen enorWe do not want to decry State journals, mously the number of these cases, and will not at all, we believe in them as a part of the completely cure a muoh larger proportion State society, for the publication of trans- than is usually supposed.

C. E. B. actions and as a mouth-piece of the organ. ization, but they can never take the place of the independent journal in the broad scope and fullness of the ultimate end of journal. BLISTERING FROM TINCTURE OF IODINE.ism. Some of the State journals, unfortun. Claret (Journal de Medecine Interne; Revue ately, in some regions, pose too much as Medico-Pharmaceutique) states that the apPhilistines—in their infallibility, their blind plication of starch, or even ordinary flour, partisanship and rather dogmatio tendenoy. with enough water to make a paste, will, when

The aim and end of all journalism is truth, applied to the injured surface, form starob and medical editors should always bave this iodide, which is barmless to the skin.-N.Y. faot fixed foremost in their mind. F.P.N. Med. Jour.

DR. J. D. MORGAN calls attention to the ne- THE REVIEWER'S TABLE cessity for greater care in the examination of Books, Reprints, and Instruments for this department, should

be sent to the Editors, St. Louis. patients having acute

articular rheumatism in Clinical


TRITION. By Prof. Dr. von Noorden, Physician in Chief to diate or remote endocar. Rheumatic

the City Hospital, Frankfort, A. M. Authorized American dial disease at an early edition, translated under the direction of Boardman Reed, Endocarditis.

M.D., Part IV, The Acid Intoxications. New York : E. B. date (Med. Record, Jan. Treat & Co., 1905. (Price 50 cents.)

13). Both patient and The author's volume on acid intoxications physician he says, often remain long unaware is well in keeping with the preceding three of any cardiac lesion. An investigation of monographs on disorders of metabolism and the records of several hospitals and dispen- nutrition. This part represents an excellent saries showed that about 51 per cent of and timely study on autointoxication with cases suffering from rheumatism were sys. acid products of metabolism, the sources and tematically examined. The proportion of formation of acetone bodies, pathologio nonheart lesions following rheumatio attauks is diabetic acetonurias, diabetic acidosis, and a about 50 per cent. Another feature of in- chapter on therapeutic considerations. terest shown was the greater preponderance

0.E.L. of rheumatic patients in dispensary ratber than in hospital work owing to tendency of LECTURES ON AUTOINTOXICATION IN DISEASE.

OR SELF-POISONING OF THE INDIVIDUAL. By Ch. rheumatics to keep up and about as long as Bouchard, Professor of Pathology and Therapeutics; Mem

ber of the Academy of Medicine and Physician to the possible. While there were three times as

Hospitals, Paris. Translated with a Preface and new Chapmany women with rheumatism in the hospi. ters added by Thomas Oliver, A M., M.D., F.R.C P., Pro

fessor of Physiology, University of Durham, etc. Second tal wards as in dispensaries, there were don. Revised Edition. Crown Octavo, 342 pages. Philadelphia : ble the number of men seeking dispensary

F. A. Davis Co., 1906, (Extra Cloth, price, $:.00, net.) treatment for the same disease as there were

This compact and up-to-date volume, so in the institutions.

excellently written, deals with the subject of autointoxication in thirty-two lectures with

an appendix of two chapters by the translaPHENACETIN is said to be of value in the

tor, embracing a comprehensive consideration

of the natural defenses of the organism treatment of pertussis.

against disease and autointoxication of intesHYDROTHERAPY IN EPILEPSY.-Guy Hins- tinal origin. Dr. Bouchard gives at length dale, Hot Springs, Va. (Jour. A. M. A., the views of other authors, but forcibly states Jan. 20), reviews the literature regarding his own convictions. The book, although hydrotherapy in the treatment of epilepsy. dealing with a subject still somewhat in obIn this country attention was first called to scurity, contains much information of every its value in this disease by Dr. Simon Baruch day interest to the geveral practitioner. A and the late Dr. G. W. Foster of the Govern. perusal of its contents will intimately acment Asylum for the Insane. Systematic quaint the readers with an intelligent undertreatment by this method is being instituted standing of the process of metabolism and in the New York State Asylum for Epileptics elimination, a subject of the utmost importat Sonyea and the results are looked for with ance nowadays for the successful manageinterest. Hinsdale believes that, as warm ment of many diseases. This edition should baths aid in the therapeutic administration increase the popularity its predecessor has of the iodides, they will also aid in the ad. enjoyed.

O, E.L. ministration of the bromids. To some extent the treatment must of course be individ.


THE THORACIC AND ABDOMINAL ORGANS. ual, and more benefit might be expected in ual for Students and Physicians. By Egbert LeFevre, M.D.,

Professor of Clinical Medicine and Associate Professor of cases of so-called idiopathic epilepsy, alco. Therapeutics in the University and Bellevue Hospital Med

ical College, etc. Second Enlarged and Revised Edition. holic epilepsy and in cases arising from

Illustrated with 101 Engravings and 16 Plates. Philadelphia intestinal intoxication than in focal or trau- and New York: Lea Brothers & Co., 1905. (Cloth, $2.25, net.) matio epilepsy.

Tbe difficulties in private Dr. LeFevre's splendid work is a represen. practice also would be greater than in insti. tation of years of clinical experience and tutions, as long-continued, systematic treat teacbing. The second edition is constructed ment and unbounded patience will be re- on the same plan as its predecessor. The five quired. Its value will be as an auxiliary parts of its contents are as follows: Part I method, modifying the dosage and aiding gives an accurate and concise description of the action of the bromids. It will also be the topographical and relational anatomy of an excellent hygienio measure, favoring the

the thoracio and abdominal viscera. Parts action of the skin and improving the general II, III and IV respectively take up inspectone of the system.

tion, palpation, percussion and auscultation

A Man


of the respiratory, circulatory and abdom- spective diseases. The book opens with 16 inal organs, together wtih a comprehensive pages of useful data, such as incompatibles, consideration of the kindred diseases. Part poisons and and a table of maximum and minV considers the fundamental principles of imum doses. With this handy volume in flouroscopio examinations.

The thorough his pooket, the practitioner need never feel at revision, with the many newly added illustra- a loss for a pertinent suggestion. tions materially increase the scope of its use. fulness. The volume is deserving of the

A Ready Reference Handhighest commendation to both student and

book of Diseases of the Skin. By George Thomas Jackson, busy practitioner.

O.E.L. M.D., Chief of Clinic, and Instructor of Dermatology, Col

lege of Physicians and Surgeons, (Columbia University), New York. Fifth edition, enlarged and thoroughly revised. In one 12mo volume of 676 pages, with 91 engravings and 3 colored plates. Philadelphia and New York: Lea Brothers

& Co., 1905. (Cloth, *2.75, net.) THORNTON'S POCKET MEDICAL FORMULARY (heretofore known as The Medical News Pocket Formulary) new The value of this volume lies in the clear(7th) edition, revised to accord with the new U. S. Pharmacopoeia, containing more than 2,000 prescriptions with indica

ness of its diagnosis and symptomatology tions for their use. In one leather bound volume. Philadel- and in its excellent therapeutic recommendaphia and New York : Lea Brothers & Co., publishers, 1906. (Price, $1.50 net.)

tions. The alphabetical arrangement also The changes in the new Pharamcopoeia renders it especially valuable as a reference were many and important. Some medioinal book for the busy practitioner and the stupreparations were nearly doubled in strength dent. This edition has been thoroughly reand their doses proportionately reduced; vised and brought fully up-to-date. Several others were much weakened and doses in- new sections have been added, and others recreased. Hence the new edition of Dr. Thorn- written and amplified. The appendix, conton's Formulary, revised not only to include taining formulae for baths, lotions, ointments, all the newer drugs, but also to accord with etc., is excellent, and will be found often to the new Pharmacopoeia, appears most timely

be a friend in need to the busy physician. and its importance is obvious.

Tbe Therapeutio Notes on the newer remedies It is not presumable that any physician will in dermatology are, also, of special value, as depend entirely upon a pocket formulary in furnishing a reliable guide in this perplexing treating his patients, but that there is a broad and constantly changing field. New editions and legitimate field of usefulness for works of by this author are always valuable and wel. this character is self-evident. Even the best come. informed pbysician may at times overlook an appropriate drug, and a young practitioner

THE NEW UNITED STATES PHARMACOPOEIA will perform his duty better, both to his patient and himself, if he has at hand the col.

makes many changes in the strength of drugs lective experience of the profession.

and preparations, reducing some, increasing

others as much as double. The law reoogThe opportunity for frequent revision is

nizes the current U. S. Pharmacopoeia as obviously of special value in the case of

the standard. To avoid accidents and dam. works dealing with a subject which advances so rapidly as therapy.

In each of the seven

age suits on the one hand, and puzzling lack

of results on the other, both the druggist editions which have now been demanded the

and dootor must follow the same standard. author has striven to em body the latest and best information, so that the profession may

As a convenient pocket reminder of these consult this handbook with confidence of changes, the importance of which must be at

once obviuus to every physician and pbar. finding it always up-to-date. Thornton's Formulary, besides being ac

inacist, Messrs. Lea Brothers & Co.,the med. curate, trustworthy and up-to-date, affords

icul publishers, of 706-8-10 Sansom street,

Philadelphia, and 111 Fifth Avenue, New other advantages which can be found in no other book of its nature.

York, have issued for free distribution a care. It is arranged alphabetically and the best

fully prepared leaflet giving an alphabetical therapeutics of the masters is therefore in

list of the important changes. The strength

of each preparation listed is given as in both stantly and handily at command in its pages.

the old and the new U. S. P. To aid in preA peculiar and valuable feature is found in the discriminating annotations. The vari.

venting untoward or negative results in the ous stages and complications of disease re

use of powerful drugs this leaflet will prove

handy and valuable. A postal card request quire treatment adapted to the conditions they present, and rational and successful therapeu

will bring a copy to any physician, druggist,

student or nurse. sis must recognize this fact. In a few clear words Dr. Thornton points out the special New CATALOGUE. - We have just received utility of each of the various prescriptions from W. B. Saunders & Company, of Pbila. recommended under the headings of the re- delphia, the widely-known medical publish

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