YEAST IN DIABETES.

Dr. Cassaët finds that a couple of ounces of yeast taken at meal-times are very useful in diabetes. At first the yeast tends to cause eructations and even diarrhoea, but after a few days the system tolerates it perfectly well and the patient finds his appetite improved, his pains less, and his general condition better than before commencing the yeast. Even in a case where phthisis was present and there had been considerable loss of weight there was a gain of several pounds at the end of a fortnight, and the dynamometer showed an increase in muscular power. The amount of sugar in the urine decreased, in one case from 32 to 7 parts in 1000.-Lancet.

SUCCINATE OF AMMONIA IN LABOR.

According to Dr. Remy, of Nancy, succinate of ammonia is very useful in spasmodic, cramp-like pains and in partial contraction of the internal os during parturition. In a case where this contraction occurred during the third stage of labor, rendering it impossible to deliver the placenta, a couple of doses of the above-named remedy relaxed the spasmodic condition and enabled the after-birth to come away without difficulty. The mixture recommended is a simple solution of the succinate in one hundred and forty times its weight of water, a tablespoonful dose being given every quarter of an hour until relief is obtained. Lancet.

Sig. Teaspoonful every two hours.- Journal of the American Medical Association.

THE THERAPEUTIC USE OF UROTROPIN.* Professor Dr. Arthur Nicolaier, of Göttingen, writes in the Deutsche medicinische Wochenschrift, No. 34, 1895:

"In a preliminary communication † I have reported that Urotropin (Hexamethylentetramin), formed, as is well known, by the union of formaldehyde and ammonia, can be used in adults in doses as high as 6 grammes (90 grs.) daily, without any unpleasant effects. I have shown that under the influence of the remedy diuresis is increased; that uric acid and sedimentary urates, previously present in large quantities, no longer appeared; and that the disappearance of these deposits was not a mere consequence of the increased diuresis, but was due to the direct action of the remedy on the uric acid and its salts. These experimental results have demonstrated the fact to me that urotropin could not only be employed as a diuretic, but that it could be employed in the treatment of the uric-acid diathesis and the various diseases dependent thereon.

"My further experiments show that the remedy is especially adapted for the treatment of uric-acid calculi; for it turned out that after the ingestion of urotropin the urine gained certain properties that made it a uric-acid solvent, without any change occurring in its acid

Chalk mixture, to make 3 fld. oz.-M.

Dose: Two fluidrachms every two hours.

"I have latterly limited myself to the exhibition of doses amounting only to 1 or 11⁄2 grammes (15 to 22 grains) daily, that amount being taken at once, in the morning, dissolved in water.

"Whilst experimenting on the solvent properties of the urine after the ingestion of urotropin on uric acid concrements in the cultureoven, my attention was drawn to another

* I have called hexamethylentetramin "urotropin," because under its use the urine is changed in various ways. The drug was obtained from the "Chemische Fabrik auf Actien (formerly

Centralblatt fuer die med. Wissenschaften, 1894, No. 51.

"I have used urotropin in two cases of cystitis, in which the urine was strongly ammoniacal, and I found it quickly efficacious in both.

"Case 1. The first case was a phthisical patient who had suffered, probably for years, from a severe cystitis. The cloudy urine contained a moderate amount of albumin, was very alkaline in reaction, and smelt strongly of ammonia. The sediment was abundant and greenish-yellow; it showed many bacteria and numerous crystals of triple phosphate and urate of ammonia. When the patient was put on 6 grammes (90 grains) of urotropin daily, a tablespoonful of a watery solution being given every two hours, some portions of the urine, even on the first day, were clear and acid. The total daily amount of urine, somewhat increased, was still alkaline; but it had lost its ammoniacal smell and the sediment was much less in quantity. On the third day the total amount of urine reacted acid; it showed only a moderate cloudiness, which was found to be composed of pus-corpuscles in small quantity, transitional epithelium, and red blood-cells. During this period the vesical pains, especially after urinating, which had previously been but slight, were somewhat increased, and they became still worse with the continuance of the same dose. I thought of the possibility of this being due to the urotropin, and on the seventh day I stopped its use. On the very next day the urine became strongly ammoniacal again, the sediment increased, the triple phosphate and urate of ammonia crystals became more abundant, and the pains in the vesical region became somewhat less. The attempt was then made to prevent the ammoniacal decomposition of the urine in the bladder by means of smaller daily doses of 0.5 to 1.5 grammes (7% to 22 grains). It was found that with doses of 1 to 1.5 grammes (15 to 22 grains) each portion of urine, as voided, was acid, but the entire daily amount reacted alkaline; it did not, however, smell of ammonia, the formation of the triple phosphates was very much less, and the urate of ammonia crystals did not appear

"Case 2. The second case was that of a patient who developed, amongst other symp. toms, after an accident, a paresis of the detrusor vesicæ, together with a cystitis with ammoniacal decomposition of the urine. This occasioned him severe pain. Though this cystitis was treated at the Göttingen Medical Clinic with bladder-washings of boric-acid solution, the patient's condition was not improved. His urine had to be drawn several times daily with the catheter; he was given large doses of salicylate of soda, 5 grammes (75 grains) daily, with oleum pini pumil., but without result. His urine was strongly alkaline, smelled of ammonia, and contained a very abundant glutinous sediment. His bladder was washed out first with a 1 per cent. boric-acid solution, and then with a 1-per-cent. carbolic-acid solution; but it only gave him temporary relief. The urine for the twentyfour hours retained its ammoniacal odor, and only those portions voided after the washings of the bladder were faintly acid. A marked improvement set in, however, when the patient was put on a daily dose of 1.5 grammes (22 grains) of Urotropin, a tablespoonful of a watery solution being given every two hours. At once, after the ingestion of the first tablespoonful, the urine drawn off with the catheter was acid, and two days later the entire amount of the secretion was strongly acid. The sediment showed only a small quantity of puscorpuscles and transitional epithelium, and the pains in the vesical region had almost entirely disappeared. That the change in the reaction of the urine and the very considerable mitigation of the pain were due to the action of the Urotropin was demonstrated by the fact that, when the patient received only 6 grammes (90 grains) of sodium salicylate daily, the urine regained its alkaline reaction and its ammoniacal odor and the pains increased again. In fact, the pains were so bad that the patient begged

to be put under his former treatment again. I granted his wish, and I again convinced myself of the beneficial effect of daily doses of 1.5 grammes (22 grains). This improvement conThis improvement continued, even when he was only taking 1 and 0.5 gramme (15 and 71⁄2 grains) of Urotropin daily. These doses caused the pus-corpuscles to disappear from the urine. When the remedy was discontinued the ammoniacal smell and the vesical pains returned. Bromalin Merck (Bromethylhexamethylentetramin), even in doses of 5 grammes (75 grains) per day, had no favorable effect in this case. At the present time this patient takes I gramme (15 grains) of Urotropin daily. His urine is acid and he has no pain. The paresis of the detrusor vesicæ continues.

"The above observations show that Urotropin hinders the ammoniacal decomposition of the urine, and that this effect can be obtained by exhibiting small daily doses,-0.5 to 1.5 grammes (71⁄2 to 22 grains)."

forms. He has employed it in twenty-two cases, and finds that it acts as a certain and powerful diuretic, diminishing the quantity of albumin in the urine and frequently causing the cedema to disappear entirely. The patients were not kept on milk diet, but were allowed to eat ordinary food, and no other drugs were given at the same time, nor any baths. The effect appeared to be more marked in acute than in chronic nephritis. The albuminuria began to decrease after a short period of treatment, on the thirteenth day, at the latest. The diminution continued up to a certain point, and then the amount of albumin became stationary; but if the salt was stopped for a few days, and then recommenced, it was found possible to obtain a further decrease in the albumin. In one of the cases-that of a woman with puerperal convulsions—the attacks, which had resisted baths, morphia, and even chloroform, disappeared after a single day's treatment with bromide of lithium. As a rule, the drug was well borne, but in two of the patients it produced nausea and vomiting, and had to be stopped for a time. In one case of acute nephritis, too, hæmaturia was produced, which, however, rapidly ceased on the drug being discontinued and some tannin being given. The mixture ordered consisted of 14 to 2 parts of bromide of lithium and 4 parts of bicarbonate of soda in 240 parts of distilled water flavored with peppermint. Of this, 3 or 4 tablespoonfuls were ordered per diem.-Lancet.

OFFENSIVE BREATH.

For hypodermatic injections.

The author injects from one to several cubic

STITUTE FOR NITROGLYCERIN AND AMYL-
NITRITE.

Dr. Lauder Brunton has tested the action of this compound clinically in cases of angina. pectoris (1 grain in an ounce of water). He arrives at the following conclusions: 1. The physiological action of nitrites, of nitroglycerin, and of hydroxylamine is alike; they all lower blood-pressure by dilating the peripheral vessels. 2. Hydroxylamine has a similar power of relieving pain in angina pectoris to nitrites and nitroglycerin, and may be employed in disease as a substitute for them. 3. Its action appears to last longer than that of nitroglycerin, and a fortiori longer than that of the

THE

Medical Bulletin.

JOHN V. SHOEMAKER, A.M., M.D., Editor. THE F. A. DAVIS CO., Publishers. 8. C. BERGER, Business Manager.

Philadelphia, Oct., 1895.

CHANCRIFORM ULCERATIVE

Ε

TONSILLITIS.

XTRA-GENITAL chancres are not uncommon and sometimes appear in surprising situations. In some positions their diagnosis presents unusual difficulty, and this is particularly true of chancre of the tonsil. In this locality it may assume the most varied aspect, simulating a phlegmonous angina, diphtheritic angina, a gumma of the tonsil, an epithelioma, etc. To add to the difficulty of establishing an exact diagnosis Dr. Mendel has lately described, upon the basis of six observed cases, a form of tonsillitis not of syphilitic character, but which bears a close resemblance to some of the forms which the initial lesion may present. The interesting paper of Dr. Mendel was communicated to the last meeting of the French Society of Otology and Laryngology, and is published in that excellent journal, Revue de Laryngologie, d'Otologie, et de Rhinologie, for September 15, 1895. As the differentiation of these lesions is a matter of great importance, we take pleasure in placing the communication of Dr. Mendel before our readers. The clinical picture of the nonsyphilitic affection is thus given: The patient complains of slight pain upon one side of the throat in swallowing. If he be an observant person he had detected, several days before the development of dysphagia, a small ulcer upon one of the tonsils. This lesion, which is surrounded by a congestive zone, is circular in form and more or less excavated. It is covered by a dirty-white deposit consisting of necrotic tissue and which can only imperfectly be detached. The edges of the ulcer are indurated. The corresponding maxillary regions contain several slightly-hypertrophied glands. As a rule there is no fever. The lesion is

indolent and heals in a variable time, which does not generally exceed a week. In one case, however, repair occurred only at the end of three weeks. The treatment consisted in painting with preparations containing iodine and the use of boric acid as a gargle.

The

In face of such a lesion one would be apt to suspect tuberculosis or syphilis. The general condition of the patient and the integrity of other organs, even the pharynx and larynx, allows us to exclude the former disease. The diagnosis between chancriform ulcerative tonsillitis and syphilis, however, is difficult. lesion may be suggestive of chancre or gumma of the tonsil. The lesion under consideration agrees with chancre in its contour, its aspect, the induration of its edges, and even, in most cases, in being limited to one side. Nevertheless there are two signs which render differentiation possible. The syphilitic chancre is always accompanied by enlarged glands, and especially by a decided increase in volume. The ganglionic enlargement may exceed the size of a pigeon's egg. In chancriform tonsillitis the glandular swelling is less marked. It needs to be sought for; on palpation there may be found two or three slightly-enlarged glands, which roll under the finger. Another important element of diagnosis concerns the mode of evolution. A chancre may take six months in developing; the chancriform lesion occupies much less time, the average being about a week. If, therefore, the diagnosis is at first doubtful, the passage of time renders it clear. In the case of a gumma we shall have a history or evidences of syphilis. In some instances, where such evidence may fail, the problem will be more difficult of solution. The duration of the lesion and the effect of antisyphilitic treatment, however, suffice to fix the judgment. Hereditary syphilis may cause ulcers of the tonsils, but it is rare that the disease will confine itself to that situation and leave the soft palate, pharynx, and nasal fossæ intact. These lesions, moreover, are generally serious, possess a different character, and pursue an altogether different course.

It remains to study the nature of this special tonsillitis. Dr. Mendel confesses that on this point he has nothing positive to offer. A prob