ago, seeing the father and daughter in both of whom the disease was first manifested in the eye. The daughter was brought to Dr. Cheatham by her father, without suspicion of kidney disease. The ophthalmoscope revealed the diagnosis, which was confirmed by urinalysis. Despite appropriate treatment she died within a year. The father came to see me about his eye some years later, saying he thought his glasses needed changing; he had complained of no other symptoms then. An examination showed a typical albuminuric retinitis. He died in six months. It is rather interesting to note that in both these cases the disease was first manifested in eye symptoms. It is a little remarkable how extensive these ocular lesions may be and still the patients have perfect or nearly perfect vision. I recollect one case, a young married lady, sent to me some time ago. She was perhaps between thirty and forty years of age, and simply complained of headache over the eyes. Her family physician had supposed the trouble was due to some error of refraction, and sent her to me to have glasses fitted. Her vision was above the perfect average, being, yet the ophthalmoscope showed a most typical and extensive lesion of the retina undoubtedly albuminuric in character. I wrote a note to the family physician, telling him that I thought from the appearance of the eyes alone I could be almost certain that it was a case of Bright's disease. The diagnosis was confirmed by examination of the urine, and the woman died in five or six months.

The prognosis where the disease has shown itself in the retina is very grave. As a general rule it is said that these cases die within eighteen months. This is perhaps a long limit for most of them, though I recall one case that lived three or four years. A business man of this city died last spring who had been under my observation several years with a typical albuminuric retinitis.

Dr. J. M. Ray. As to the prognosis: We know that this form of kidney affection is essentially a chronic disease. Some of the cases Dr. Simpson reported went along two or three years before the end came. Again we know that in a great many cases the first symptoms that attract our attention are the eye symptoms, and if that is true it is strange that in the majority of the cases in which the eye becomes involved the length of life is not greater than eighteen months. Bull, in the cases he collected, showed that nearly all died inside of eighteen months. If that is true, then the eye symptoms must as a rule be late symptoms. In cases like Dr. Cheatham reported, in which the eye

symptoms were present and no albumin in the urine, certainly there must have been evidences of sclerosis elsewhere. I have seen two cases in which albuminuric retinitis lasted over three years, but the large majority die inside of a year.

Dr. J. B. Marvin: Even where there is a large quantity of urine, many of these patients complain of a burning, stinging sensation along the urethral tract upon micturition, which I take to be due to the presence of oxylate of lime or uric acid, and water, as suggested by Dr. Bailey, is a good solvent and diluent, even though the patient may be passing as much as a gallon of water per day.

Dr. F. C. Wilson: The ground has already been very well covered, and there are only a few points to which I would direct attention: The natural history or natural course of the disease under consideration is characterized by periods of amelioration and exacerbation. The patient may almost approach death, the symptoms of uremic poisoning being well marked, yet he may get over that, the symptoms may all subside, and the patient get up and probably be comparatively comfortable for months afterward. He may go along this way, having a number of exacerbations for months or even years, without the end coming, as it will likely do sooner or later from general uremic poisoning.

There is one question that I desire to ask Dr. Marvin as to the use of chloral, and that is the danger of causing softening of the brain. We know the prolonged and habitual use of chloroform has this effect. I have been somewhat chary, although I have used chloral a great deal in these cases, and with decided benefit, yet I have always been a little uneasy lest ultimate softening of the brain take place, as we know this does accompany artero-sclerosis.

I believe the best remedial agent that we have for use in these cases is nitro-glycerine; this with careful regulation of the diet and habits of life constitutes about all we can say as to treatment.

Dr. F. C. Simpson: It was my intention in writing a paper on the subject of interstitial nephritis to bring the question before the society for general discussion, as I have had some experience with the disease, some favorable and some that was not. In some of the cases I thought some good followed the administration of remedies suggested in the paper, regulation of diet, etc. I still look upon the nervous system as being most concerned in the production of interstitial nephritis, possibly through the influence upon the heart. I do not know to what to

assign these troubles except to the nervous system, and as stated I have met with a number of them in women just about the time of the menopause.

So far as the condition of the kidney is concerned, if I understand the matter correctly the attack commences in the tubules; one after another is attacked, and the trouble extends until contraction of the kidney takes place to such extent that the entire kidney becomes cirrhotic, and in this stage we are not as likely to have albumin and casts in the urine as during the earlier stages. In all the cases I have had I have submitted the urine to both chemical and microscopic tests; these tests were all made by competent men, and in a number of cases no trace of albumin or casts was found. This might be, as Dr. Marvin says, on account of the low specific gravity of the urine, that the casts float, and by the use of the centrifugal machine spoken of (which was not employed in the cases I have reported), by taking fresh urine and throwing the sediment, by the aid of this contrivance casts might have been discovered.

In regard to treatment: I have gone over the whole list of drugs with varied success and failure. The pulse, as has been stated, is our best indication as to what is needed. You may use nitro-glycerine, strychnine, and other remedies, but you have to be guided entirely by the condition of the pulse. I have certainly gotten some good results from the administration of opium in these cases. I consider it very valuable, especially to enable these patients to obtain rest at night. I usually give one eighth grain of morphine with one hundred-andfiftieth grain of atropine hypodermatically. I have used chloral and have gotten good results from it. I have used nitro-glycerine a great deal. I have used the infusion of digitalis when the kidney did not seem to be excreting very rapidly, and have given it in large doses in the condition spoken of where the quantity of urine was small. It may not be indicated in cases nearing the close where the quantity of urine is small, with low specific gravity, but I have certainly gotten beneficial results from the infusion of digitalis and acetate of potassium in the earlier stages of the disease.

The point that I especially desired to make in my paper is that some of these go on for a long time unrecognized; this is a feature I want to emphasize, and suggest that a closer investigation be made of all cases that come under our observation where disease of the kidney is even suspected. Of course the older practitioners are as much

impressed with the importance of this as I am, but the younger members of the profession need to be cautioned upon these points. I have been called to see a number of these cases that were not recognized by the attending physician until just previous to death.

JOHN MASON WILLIAMS, M. D., Secretary.

Foreign Correspondence.

LONDON LETTER.

[FROM OUR SPECIAL CORrespondent.]

The X-Rays and Tuberculosis; The Medical Directory; The Use of Aniline Dyes; Hygiene for the Poor; Influenza in London; An Aseptic Ward; The Drink Cure; Oysters and Typhoid; Hygienic Condition of French Army.

Professor Grunmach, head of the Roentgen Laboratory in the Berlin University, has stated that, judging from his own observation, the various reports of the cure of tuberculosis of the lungs by means of Roentgen rays are extremely improbable. He adds, however, that several cases of lupus have improved surprisingly after their application.

The medical directory, for now over half a century issued annually, shows that year by year the number of medical practitioners increases by at least 500, and this year those enumerated at home and abroad are 34,903, an increase on last year of 619. London alone counts over 6,000, or within 1,000 of the whole of Wales, Scotland, and Ireland.

Sir John Hutton, president of the Sanitary Inspectors' Society, recently delivered his New Year's address. He said the aim and the result of the association were to promote longevity, and he considered their efforts had been very successful. In London, in 1660, the death-rate per 1,000 was 80, and in 1896 it was 18.9. This diminution was all the more remarkable when the enormous increase of houses in London was considered. In 1801 the number was 142,042. This had increased in 1831 to 246,839, and in 1896 to 596,030. In 1801 953,788 persons lived in the metropolis, but in 1896 these numbers had swelled to 4,443,018. Sir John thought that the present death-rate of 18.9 per thousand could be still further reduced. The water question he thought ought to be seen to, and that London in future years would regret her suicidal indifference in obtaining a better water supply. The maidstone epidemic of typhoid, with its 1897 cases, should be taken as a warning as to what would happen if London were attacked.

At a meeting of the Medical Board held at King's College the following report was read: "The board of the medical faculty of King's College report to their council that they are in favor of the scheme for a new university of London embodied in the Bill of 1897, and would desire that the delegates should obtain those amendments that are recommended in the report."

The public analyst for Marylebone, in a report just issued referring to the coloring of margarine with aniline dye so as to resemble butter, expresses a hope that the proposed amendment of the Sale of Food and Drugs Act, will make it an offense to color foods with aniline dye unless the purchaser is informed of the fact. Dr. A. Wynter Blyth concludes by saying aniline dyes possess such great tinctorial power that even with those that are poisonous the quantity taken, in the consumption of any one ordinary colored article is most minute, so that in few cases could decided symptoms be produced. On the other hand, when sugar, butter, milk, cream, sausages, confectionery, and a number of other things all have a small trace of aniline, these traces in the day total up. Observation and experiment have shown that the aniline dyes in small doses interfere with digestion. Dr. Blyth is of opinion that the increase of maladies of the digestive organs is in part due to the increasing use of the aniline colors and to the use of antiseptics, such as boracic acid, formalin, and salicylic acid.

The London Mansion House Council on the dwellings of the poor have arranged for the delivery of lectures in various parts of the metropolis on the subject of domestic hygiene and the proper attention to sanitation in the houses of the poor. The subjects will be described as "Healthy Homes" and "The Essentials of House Sanitation." The practical question is, if there be any real enthusiasm raging in the poor man's breast concerning the sanitation of homes. It is generally too often felt that a few smells here and there is no ones business, and he who treats them with contempt soon gets used to them. Then, again, are many of the working poor, who keep the cabbages and other articles of their stock in trade under the bed and sleep four or five in a room, ripe to accept with fervor the well washing and proper ventilation of their one room.

According to the Registeur General's returns of mortality due to influenza in London, in 1893 the direct mortality was 1,525. In 1896 there was a fall to 750 directly fatal cases, most of which occurred in the early part of the year. In 1895 there was a severe outbreak in February and March, altogether 2,156 direct deaths were recorded, of which 1,570 took place between the middle of February and the end of March. In 1896 the mortality was the smallest since the reappearance of the disease; the 496 deaths were uniformly distributed. In 1897 the direct mortality was 656. The present recrudescence of the disease is chiefly in the West, North, and South of London. It is thought that the most favorable climatic conditions for influenza in England are normally found in the