66 On exposure to the air it becomes quite | puzzling, and that he was reminded yellow, then gradually whitish and that the water bore a close comparison turbid in appearance, and finally clear with that of Stachelberg, in Switzeras crystal. When put in barrels it re- land." The Stachelberg Spring was quires a long time for this process to first described in J. J. Schenchzer's complete. This peculiar action of the Hydrographica Helvetica," which was water seemed to settle its fate. No one published in 1717; the spring has been seemed able to understand its changes, known as a medical water for certainly and being utterly unlike all other two hundred years. In 1812 it was the waters handled by the druggist, he subject of a special brochure by Dr. could not venture to explain its action. Johann Martin, of Glarus, who pointed At this time no thought was enter- out its peculiarities, which tempted tained of the water forcing itself into Prof. C. F. Kielmeyer, of the Univerrecognition as a medicinal agent of rec- sity of Tübingen, to attempt its analysis ognized value. Reports were being and explain its properties from the daily received from physicians and chemical characters found, and as they others attesting its worth in rheuma- were then understood. tism, gout, derangements of the kidney and diseases of the bladder, its power to dissolve renal calculus, and its beneficial effects in chronic syphilitic and all lithæmic conditions. These reports led us to suspect that this very extraordinary chemical conduct of the water was the key to its wonderful medicinal action, and stimulated further search into its chemical character. Prominent physicians who had prescribed the waters were well pleased with the certainty of its action, but could not understand its chemical deportment. Dr. George E. Walton, author of "Mineral Springs of United States and Canada," and well informed upon all mineral waters, after investigation, wrote: "The water reveals peculiar and extraordinary properties such as I have never met with before. These properties are not met with elsewhere in this country. Two or three springs similar are noted in Europe-Enghoem and Cadeac, France. I do not doubt that this water will prove applicable to a wide range of diseases. You may be assured the water is one which should not be neglected." It was suggested that Prof. Karl Langenbeck, Professor of Chemistry in Miami Medical College, would be able to unravel the chemical action. He began its analysis in February, 1889, and worked upon it until May 15, following. In response to inquiries as to the difficulties and delays in the work, he replied, "that the work was very In 1834, Dr. Theodore Simmler, then an instructor in the Polytechnic School at Zurich, saw that the great discoveries in chemistry, made since the date of Keilmeyer's celebrated effort, had not been applied to the analysis of the alkaline hepatic waters, the character of which was not understood in spite of Kielmeyer's work in the light of advanced chemical knowledge. He therefore undertook a new analysis of the Stachelberg Spring, and the methods devised by him in this very puzzling work have held good in the examination of this class of waters to the present day. Working in the Zurich laboratory myself during the year 1882, I became familiar with Simmler's work and the Stachelberg water, as the resort is in the valley of the Linth in Canton Glarus, not far distant from Zurich, and popular with the Zurich people. Medical experience with it extends over so long a period, and it has played so important a part in stimulating advance in the chemical analysis of complicated waters, that it is well known to chemists who are familiar with the history of this subject; and it should be known to physicians generally, that a similar water can be obtained in abundance which falls heir to the extensive experience that has been made with it. The resemblance lies chiefly in the alkalinity, the character of the sulphur compounds, their change from sulphides to sulphates on exposure to air, the presence of monosulphides, hy Calcium hydrosulphide 0.3230 ... 1.1050 66 66 4.35 cub. inches. Carbonic acid gas.... The quantity of lithium carbonate is the same in each analysis-8 8/10 grains to the gallon. Prof. Dr. Roberts Bartholow, of Philadelphia, took a case in bottles and a barrel of the water for trial. He wrote "that he was much pleased with the results of its use; that it acted efficiently in uric acid diathesis by forming chemically the urate of lithia, which is easily excreted in the urine." He also gave great credit to the numerous sulphur compounds held in the water in the form of the normal sulphides, the monosulphides, the hydrosulphides and the polysulphides changing into sulphates, and believed" the chemical action, as observed, continued during ingestion, therefore exerting alterative and reconstructive changes that favorably modified morbid processes in the liver, kidneys, and glands of the stomach and bowels, rendering it a most valuable medicinal agent." Before he completed his investigations he became ill, and we were deprived of an authentic report from him. By this time many reports from physicians prominent in the profession were received concurring in Professor Bartholow's observations and establishing that in lithæmic conditions where the tissues are in a state of irritation from the retention of excrementitious matter, where fugitive pains, irritable temper, loss of appetite, and insomnia are present, and the urine full of urates, the action of the lithia in the water changes the condition, and where the salicylates, and so on, failed to ease the pains, opiates, chloral, etc., failed to bring sleep, and where pulmonary troubles, paretic dementia, and heart failure seemed imminent, and no improvement made under the use of means hitherto employed, the water, by its chemical action in uniting with the urea, renders it perfectly soluble and easily carried off in the urine, thereby affording relief and effecting a cure. Numerous reports of cases of this kind sustain the theory of its chemical and physiological action as a solvent and eliminant of urea, the presence of which is the cause of so many obscure, chronic, and painful affections. The last and probably most important medical property of this water to which your attention is called is its action in dissolving renal calculi. This property is attested by reports of many cases, a few of which only I will here mention: Case I-Dr. J. O. Jenkins, of Newport, Ky., reported a case in the LANCET-CLINIC of December 6, 1890, who, after using the water some time, passed at one sitting five ounces of sand. Some months afterward, at one sitting, three and one-half ounces of sand, and smaller amounts at other and frequent times. The Doctor believed" that the action of the water was, that the outer layer of a large calculus in the kidney (for the stone was not in the bladder) was dissolved, and the internal and harder as well as older portion would require the continuance of its use to break it up." The Doctor afterward reported "continued improvement in the case, with unwavering faith in the water." Case II-Mr. W. B. T., of Portsmouth, O., complained of uneasy sensations referable to the urinary organs. He had no intimation of the cause. From curiosity, perhaps, he drank of the water. After a few days' use he was seized with severe renal colic, which was relieved only by hypodermic | to the taste, yet many become fond of it use of morphia. He continued the use by use. It renders the bowels soluble, of the water and was the second time but it is not a cathartic. It does not act the victim of renal pain. This time his violently upon the kidneys as to set up physician accused the water of the mis- nephritis. It is a solvent of urea and of chief, and condemned its further use. In the various morbid deposits from the a few days more a third attack super- urine. It is a bile solvent, and acts well vened. A calculus reached the bladder, in hepatic affections, especially cirrhosis. entered the urethra and was removed. It is an eliminant and reconstructant. It The water had got in its work, settled is an antizymotic, antiseptic, antituberthe diagnosis, and gave relief not experi- culous agent of no mean value, because enced for a long time previously. of its calcium sulphides and other sulphide and sulphur compounds. Some mineral waters act as distilled water only, by holding in solution no agent whatever. They must be used in large, drenching, flushing and flooding quantities to take up the salts and wash them out. This water acts chemically, physiologically, uniformly, invariably and infallibly, in the direction of the modus operandi of its composite ingredients, requiring no flooding, no sewerage process, nor taxing the kidneys to diseased tension to produce appreciable results. It never spoils, nor loses its medical properties. The bromide and lithium remain constant. Case III-Mr. F., aged sixty, a patient of Dr. J. C. Winters, of Ripley, suffered from an irritable state of the urinary organs. No suspicion of renal calculus was entertained. He drank the water, and it was not long until the doctor was called to remove a large calculus engaged in the urethra. Recovery seems to be complete. Case IV-Capt: K., of the Big Sandy Packet Co., drank the water on account of vague abdominal pains and urinary discomfort. In a short time he was seized with violent renal colic, which he never had before. His physician accused the guilty water, and advised its discontinuance. But the water had already begun the solution of the calculus, which was reduced to a size that would permit its entrance into the ureter and exit by the urethra. His relief after the passage of a large stone was perfect. Case V.-Mr. H., of Flora, Ill., was advised by his physician, Dr. E. B. Elrod, to drink the water for an obscure affection referable to the kidneys. He came to the spring and drank of the water probably ten days, when he was seized with most violent renal colic. In a few hours he passed several drams of sand, and for several months continued to pass this débris. He was advised finally to cease using the water or it would kill him. He afterward returned to the spring to use the water, realizing what it had done for him. He remains free from renal pain to the present. These are but a sample of a large number of reports of like character received. We summarize from observation, trial and a large number of reports, the following: That the water is not a table water, but medicinal. It is not pleasant As" ipecac vomits and jalap purges," so bromo-lithia water excretes urea, dissolves renal calculus, arrests excretion of albumen and dries up the mysterious, sweet fountain of diabetic urine. The Ice-Cradle. Soltau Fenwick (Berliner klin. Wochenschrift, No. 31, 1892, p. 767) describes a device that has been employed at the London Fever Hospital for ten years in the treatment of cases of typhoid fever, and, more recently, of cases of pneumonia attended with hyperpyrexia. An ice-cradle is made by suspending over the patient, in bed, by means of iron frames, a number of zinc buckets, kept half-filled with ice and inclosed in a light covering. The patient is covered with a muslin sheet, and provision is made for the circulation of the air in the cradle. The temperature of the patient is to be taken at least every four hours, and if it falls to 100° the apparatus is to be removed. If a sense of chilliness appears, hot bottles are to be applied to the feet.-Medical News. DISCUSSION. DR. EDWIN RICKETTS: I believe it is not justice to this paper to pass it by without discussion, for the reason that it is a subject worthy of our attention. It is one thing, outside of my abdominal work, which I look after, in connection with surgical diseases of women, and, while my experience has been somewhat limited, yet I would like to ask the question: Are we sure as to the diagnosis of these troubles? With all of my cases of this kind, I have but one which is worth reporting, so far as a cure is concerned. Six years ago a young lady, about eighteen years of age, consulted me about a tumor in her breast, and I advised the removal of the breast and with it the growth. This was done, and the tumor, weighing 300 grains, was turned over to a microscopist, who pronounced it a cancerous tumor of the round-celled sarcoma specia. She is now apparently well. I will say, however, that I have had cases where I was as much at sea after the microscopical examination as I was before, and I would say that if we were to expect much of importance from them in early diagnosis, our microscopists must take some steps forward. The same thing holds good in cancer of the uterus. A case of near two years ago, which I reported here, in which four of our best microscopists were divided, two claimed that it was cancer of the uterus, and two that it was not, and when sent to Dr. Kundrot, he said he would not venture an opinion. This patient is today in good health. The use of escharotics I have never advised, and I think, as the Doctor stated, that this is not the correct method. But, we must get at these cases early. The laity must be educated to recognize the importance of consulting the family physician so soon as a growth appears upon the breast, be it malignant or non-malignant. I may be criticised on the case reported for not opening up the axilla space. I removed the growth on general principles, and my views that it was malignant was corroborated by the microscopist afterward. I will admit that this case was handled in its very earliest stage. I am an advocate of the knife, and of the knife used early. And we cannot obtain good results, save when we do resort to the knife early. In regard to the open method of healing by granulation, I believe it is a good method, and believe it is the one described by Dr. Dawson years ago. I have resorted to this method in some cases, but in the case described I did not remove the breast entirely, and did not attempt to heal it by the granulating process. It does seem to me in those cases in which the axillary glands are involved, that the opening up of this space and removal of these glands is demanded so far as prolonging the life of the patient and freeing her of much pain is concerned, yet I fear we cannot promise a cure in all cases; just as in case of cancer of the uterus, when the uterus becomes fixed, or when the cancer has extended into one or both broad ligaments, there is no use holding out any inducement to that patient so far as cure is concerned. If we are to expect good results, it must be after the earliest possible recognition of the disease. And, no wonder so much reproach has been cast upon surgery, for the reason that more than the majority of these cases have been operated on when it was ridiculous to operate from the standpoint of cure. There must be a halt called. There must be a halt called, I say, in regard to the extirpation of cancer of the uterus. There must be a halt called when it comes to operating on cancer of the breast, after the glands of the axilla have been involved. | never had an attack of pain since the If we can hold out the inducement that operation, and was able the past summer it will prolong life, then the operation to attend to his duties about the house, is worthy of its doing; but, in too many and assist his father some in practice. instances I am afraid that too much is There has not been a return of pain, and promised; while, on the other hand, we he is apparently as well as he ever was should be very conservative and not hold in his life. It was my intention to preany inducement outside of prolonging sent the patient to-night, but I have not life to a certain extent minus the suffer- been able to do this. However, it affords ing they will have, if not operated upon. me pleasure to say that the case excited DR. MCMECHAN: some interest among such eminent surgeons as Christian Fenger, of Chicago; Thomas Manley Morris, of New York; Lawson Tait, of England, and other prominent surgeons, who have written to me as to the removal of this appendix before there was much pus; and I hope, if at some later time anything should go wrong with this patient, to report it here. The main reason I reported this case was that it had been treated by a man who calls himself a cancer doctor, and is accustomed to removing cancers by escharotics, and I thought it would be interesting to the Academy to know the results in this case. I think had the cancer been removed by the knife she would have had less suffering. I am a general practitioner, and do not often come across these cases, but I remember about ten years ago a patient, a woman about fifty years old, whom I examined. She appeared to have a small cancerous tumor on the breast, and I advised the removal of the breast. She thought that would be rather a large operation for such a small thing, but finally consented. After its removal she got. entirely well. That, probably, was not a malignant tumor, as this was. DR. EDWIN RICKETTS reported a Case of Appendicitis. I have a supplementary report to make here to-night. I make this report in order to have it go in the proceedings of the Academy. I read a paper on this subject here last February, and reported this case, but for some reason it did not find its way into the proceedings of the Academy, nor was it referred to by the retiring President in reviewing the year's work of the society. The case is that of appendicitis, in which the appendix was removed. The patient was a student of the Ohio Medical College. As reported, the appendix, with a gelatinous tumor, was removed, and the specimen was presented. The young man made a nice recovery. When the case was reported, it was said by one of the members that it remained to be seen if a cure was effected. He has Purifying Water. Dr. Daremberg, writing in La Médecine Moderne concerning the means of rendering a cholera-infected water innocuous, says that this end may be accomplished in one of three ways, viz., by filtering, by boiling, or by the addition of some chemical substance which will destroy the germs of the disease. The first of these methods is, as a rule, ineffective, and can be relied upon only when every detail is most scrupulously attended to. The second is effective but troublesome, and can not always be carried out, fire and a suitable vessel for boiling being indispensable. The third method is one which, he says, is equally effective with boiling, and which can be carried out anywhere and at any time. The purification of water has been effected through the addition of alum, but the author prefers the acidulation of the water, especially in the case of possible cholera infection. Citric acid may be added to the water in the proportion of sixty to eighty centigrammes to the litre. This method is inexpensive, does not impart any unpleasant taste or odor to the water, and can be done anywhere without the need of cumbersome or delicate apparatus. In place of citric acid, tartaric or hydrochloric acid may be used, if desired.N. Y. Med. Record. |