died finally as the result of an accident. Another is now county supervisor whose lungs are as sound as his head, which is said by his colleagues to be the soundest on the board.

But such testimony, while substantiating and verifying the strongest statements, is lacking in the essential features which would make it of value from a scientific point of view. There are few, if any, of these persons who can give any definite description of their physical condition previous to arriving here. None have from their old medical advisers records of the results of physical examination or the exact diagnosis of their case. To supply this deficiency, I am preparing a report of some carefully-studied cases that will be ready for publication in a short time.

THE EFFECT OF SCARLATINAL POISON ON THE KIDNEYS; THE CHANGES INDUCED. SUGGESTIONS ON TREATMENT.

BY M. HAGAN, M. D., HEALTH OFFICER OF THE CITY OF LOS

ANGELES.

THE kidneys are the principal scavengers of the body; they not only remove the natural excrementitious substances from the system, but poisons, whether introduced or generated, in the system are mainly through the functions of the kidneys eliminated and expelled from the body. And it is probably through the effort of the kidney to eliminate the poison of scarlatina from the blood that the organ becomes diseased itself. The debris excreted by the kidney in this disease is charged with a specific virus, that is irritating to the organ and liable to produce nephritic lesions. The injury to the kidney in these cases, ranges from slight irritation to absolute inflammation, depending on the quantity and quality of the poison in the blood.

Many careful observers hold that the kidneys are always affected in scarlet fever, and that, in some degree, nephritis is as common as the rash on the skin. And further, that sore throat and nephritis does occasionally occur without the rash. These cases are only observed in severe epidemics, and when surrounded by children suffering with rash and sore throat. This latent form of scarlatina can only be correctly diagnosed on the approach of dropsy, its characteristic sequel-there

being no rash, but mild fever and slight sore throat. These cases always occur in families where the balance of the children have the usual rash and catarral angina.

Of the various dangerous complications and sequelæ of scarlet fever, none are more important, or more dangerous to immediate life or to subsequent health, than the derangement of the kidneys. And, as a clinical fact, almost all cases of fatal scarlatina present renal symptoms. In the primary stages of the disease the nephritic symptoms may be overlooked, or may not be distinctly recognizable until dropsy develops. Here, too, is a common error, especially among the laity, and not very uncommon in the profession, the belief that dropsy following scarlet fever is the result of cold. Many an unhappy mother, who has lost her child from this disease, reproaches herself for years for having changed its linen too soon, or imprudently opened a door, and thus brought about the death of her child. Now, it is possible that chilling of the skin during the fever, or more especially during convalesenee, may favor congestion and inflammation of the kidneys; but the prime cause is the irritation produced by the scarlatinal poison. Acute nephritis is so common in scarlet fever that close supervision should continue over the patient for some weeks after all evidences of the disease have disappeared. From the beginning, every case of scarlet fever should be managed with a view to preventing renal lesions. An examination of the urine should be made daily, and should be taken from a vessel containing the whole amount of urine passed during every twenty-four hours. Simply, a test for albumen is not sufficient, as albuminuria may be due to other than nephritic causes. And, as a matter of clinical experience, demonstrated by autopsies, albumen is not always present in renal disease. A very refined microscopic examination, however, is not necessary to find coagulated fibrin, renal epithelial casts and blood corpuscles-which will determine as to kidney complication. Dropsy is a very common, but not an invariable symptom of this form of renal affection, and its extent is just in proportion to the failure of the kidneys to perform their functions.

TREATMENT.-From the beginning of a case of scarlet fever, an eye should be single to the protection of the kidneys. The treatment instituted during the fever, should have in view the

Close attention

relief and preservation of those organs. should be given to the skin the first few days. Sponging with tepid water, hot baths and hot packs, also daily applications of some unirritating oil to the surface of the body. The latter relieves the itchings of the skin and diminishes the fever from one to two degrees-to say nothing of the theory that the germs of infection are less liable to pass into the air, after their wings are coated with oil. Mild saline cathartics aid in eliminating the poisons from the system, thereby relieving the kidneys, and should not be disregarded during the height of the fever.

But, with the first symptoms of renal trouble, we have two propositions to meet: First, that there is a specific poison in the system that has produced kidney disease; and, in the second place, in consequence of this renal disease, the blood has become further contaminated by retention of urea and other excrementitious matters.

Our aim in the treatment at this stage should be to rest the kidneys, and eliminate the poisons from the blood by means of other excretory organs. To carry out this order of treatment, the patient should rest in bed or in a moderately warm room. The skin and bowels should be encouraged to act freelydiaphoretic medicines should be alternated with saline purgatives. Early in the disease a sinapism, or some mild counterirritant should be applied over the region of the kidneys. When the urine is scanty and highly albuminous, cupping or leeching on the loins should not be neglected. Here, again, the alkaline salts are useful and efficient, of which class the bitartrate of potash is the representative. Digitalis is the least irritating to the kidneys as a diuretic, and owing to its tonic effect on the heart and arterioles its administration is proper and highly beneficial.

Convulsions occurring in this disease should be treated similar to those occurring from other causesa proper dose of morphia hypodermically administered during the convulsion, and bromide of potasium and other remedies during the intervals.

Where excessive dropsy threatens to destroy life, dydragogue cathartics should be temporarily resorted to, but their prolonged use in a disease with such marked anæmic tendencies would be, to say the least, ill-advised. Pure drinking-water is

never objectionable in any stage of this disease, and may very materially assist in washing away obstructing coagula from the kidneys, and thereby shorten the disease. After the poisons are eliminated from the system, and after the force of the disease is spent, tonics are indicated, and here the muriated tincture of iron, on account of its combined diuretic and tonic properties, is most valuable.

OLIVE OIL IN LIEU OF CHOLECYSTOTOMY FOR
BILIARY OBSTRUCTIONS.

BY J. MCF. GASTON, M. D.,

Professor of Surgery in the Southern Medical College, Atlanta, Ga. IN my article on "Obstrution of the gall-duct and its bad consequences, etc.," will be found, at the foot of page 361 of the October number of Gaillard's Medical Journal for 1884, the following statement:

"If curative measures are resorted to early after the interruption to the flow of bile, there is a good prospect of evacuating the gall-bladder. Dilitation of the ductus choledochus may permit of the forming of gall-stones the size of an ordinary plum-seed, and the results which have been reported recently under the olive oil treatment commend themselves to the favorable view of the profession at large."

In reporting the treatment of a case in which my diagnosis was, obstruction of the bile-duct with dilitation of the gallbladder, containing a considerable quantity of semi-fluid bile and a large biliary concretion, the accompanying details are given, on page 368 of the above-named journal:

Having observed the reports in regard to the use of olive oil in cases of hepatic colic, with the result of dislodging gallstones, it was thought that, if it did no good, it could do her no harm to try the experiment of a full dose of the oil. She took a teacupful of the sweet oil, such as is used for the table, at intervals of three hours, until three were taken, when the stomach refused to accept any more. In the course of the same night she had four evacuations, of a dark grumous matter, which continued for twenty-four hours with greater or less intervals. After the first discharges there was very little of

the characteristic foul odor with the evacuations, but a disagreeable smell (which was sui generis) accompanied the dejections of the semi-fluid matter that passed, and which had been previously retained within the gall-bladder. In the meantime the tumor extending below the ribs on the right side diminished, and the hard mass, already described, receded upward to the margin of the ribs. The pain and sensitiveness in the epigastrium ceased, but in the course of a week the darkish discharges disappeared, and eventually there was no further action of the bowels. The patient again became uncomfortable, and the olive oil was repeated, with a good result in producing discharges, resembling the former matter, but less in quantity, which recurred at intervals subsequently.

Her appetite now returned, so that she ate indiscriminately of such vegetables and other articles as she desired without any indications of indigestion, and eventually there seemed to be a restoration of the proper bilious secretion to the evacuations.

To obviate the necessity of any operative procedure in a patient suffering from biliary obstruction with very considerable enlargement of the gall-bladder, in the hospital connected with the Southern Medical College, I ordered liberal doses of olive oil, with a most salutary result, during the past three months.

This man, whose name is Paul Joblouski, by birth a Pole, was seen by Prof. W. D. Bizzall and myself, on the 2d of October, 1886, laboring under torpor of the bowels with jaundice and a tumor on the right of the median line extending from the false ribs to the level of the umbilicus. We concluded that this was a prolongation of the gall-bladder, associated with some obstruction of the common bile-duct and hepatic disorder, for which calomel and bicarbonate of soda in broken doses was administered with only temporary relief of his troubles. After many other measures had been resorted to by the Home physician, Dr. Powell Walker, I conferred with Dr. W. A. Crow, who was co-operating in the management of the case, and suggested the use of a pint of olive oil in two doses with an interval of three hours. This brought away copious discharges of dark semi-fluid accumulations, and though no gallstones were passed, there was a reduction in the tumor, with marked relief of the sufferings of the patient. He was di