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I would not like to be without Leucin in cases of nephritic affections. If the pathological change has not yet reached the last stage I have hitherto always experienced a favourable effect.

Mr. Schwertfeger, at. 28, merchant, had been treated allopathically for two years for gastric catarrh. Nine months before I saw him, dropsical symptoms with albuminuria had shown themselves, for which Pot. acet., Tannin, Plumb, acet., diaphoretics, and the water cure had been tried with but little effect. In spite of great weakness, the patient continued in business. I did not search for morphological changes. Under the use of Hypoxanlhin 4 and leaving off the diaphoretics, the dropsy increased, so that after four days I gave Leucin °°4, five drops, every three hours. After eight days there was perceptible decrease of the dropsical symptoms and increase of strength. The quantity of urine was apparently not increased; the albuminuria unaltered. Not till four weeks later did the patient observe an increase in the renal secretion. After seven weeks I found a decrease of the albumen to two thirds of its previous volume and complete disappearance of the oedema. The symptoms of gastric catarrh had also gradually declined; the heartburn, the frequent eructations, the constipation had yielded to a more healthy state of the digestion. The patient got medicine for fourteen days longer and then ceased treatment. Ten months later there was no return of oedema or albuminuria, but the gastric catarrh manifested itself again in loss of appetite, discomfort, pressure in the stomach even after simple food, and troublesome heartburn. Leucin removed these symptoms.

Dysentery.—I have seen the remedial power of Leucin in four cases, but must confess that in one case the bloody, slimy stools and tenesmus only yielded after ten days, and in another only after seventeen days, though Leucin was given from the commencement of the disease.

In fatty degeneration of the cardiac muscle and in affections dependent on degeneration of the heart, I frequently saw good effects from this remedy, after the employment of other remedies both by myself and some of my colleagues had been without benefit.

Cholesterin, CtfH O.

occurs:

A. Physiologically.

In the bile of the higher classes of animals, in the serum of tho blood, in the blood-corpuscles, in the cerebral and nervous substance (copious), in the spleen, yolk of egg, in normal transudations, smegma preputii, in the contents of the intestines, faeces, meconium. The mode and material of its formation in the organism are unknown. Cholesterin has been found in peas, beans, and lentils, also in cereals. It seems to be an essential constituent in all cells capable of development.

B. Pathologically.

In gall-stones, which consist mainly of Cholesterin. In the urine in icterus, diabetes, in fatty degeneration of the kidneys. In dropsical exudations. In pus, cysts, and echinococcus cysts, in obsolete tubercles, degenerated ovaries and testicles, in cancerous tumours, in the expectoration of tuberculous patients, in the cataractous lens, in the atheromatous formations in the membranes of blood-vessels.

Cholesterin crystallises in white, mother-of-pearl, shining, greasy-feeling scales. Under the microscope it appears as transparent, rhombic tables. It is tasteless and inodorous, and in dry distillation it furnishes an agreeable, geraniumsmelling oil. Insoluble in water, soluble in boiling alcohol, from which it is precipitated on cooling in the form of crystals; soluble in ether, chloroform, benzol, and petroleum.

I triturate it with milk sugar to the third cent. trituration, and prepare from this the fourth dilution.

Owing to the great distribution of Cholesterin and the obscurity of its origin, it is difficult to define sharply its sphere of action.

It seems to me likely to be of use in the treatment of carcinoma, especially carcinoma of the liver. Though most of my colleagues are sceptical on this subject, I intend to investigate the matter more thoroughly hereafter in order to collect indisputable evidence. I am convinced that in this or some other way we may by and by succeed in finding some means for combating this dreaded malady.

After many unsuccessful trials, e.g. in tuberculosis, cataract, suppurative processes, I am able to define a sphere of action for this remedy, though not very sharply. It appears to me that pathology has not yet provided us with any very clear substratum for every hepatic disease. There are diseases of the liver, the diagnosis of which cannot yet be scientifically established. I know not if pathological chemistry will be able to supply this desideratum, though I incline to think it can. I believe that an accumulation of Cholesterin in the liver (where?), with or without the formation of gall-stones, can supply us with a probable cause for some of those affections, which do not directly cause death and hence leave behind them no physical pathological changes. In order to explain my views I will relate the following morbid histories of certain liver affections and gall-stones.

Mr. Bethke, at. 42, of robust constitution and thin, had suffered from icterus fifteen months previously, and since then from a stomach catarrh. Appetite small, much frothy saliva, flat taste, sallow complexion, moderate crepitation, much flatus expelled from the bowels with difficulty. Left lobe of the liver more sensitive to pressure than the gastric region, not perceptibly enlarged. The ordinary stomach remedies were of no use, and Sepia °°3 and 500 did no good. Cholesterin, third trit., 01 gramme three times a day caused considerable improvement in the first fourteen days, and restored the health completely in three months.

Emilia Drager, set. 39, has suffered for two or three years from occasional pains in the stomach, not dependent on food, which extend to the chest and right shoulder. The hepatic region is more sensitive than the prsecordium; frequent eructation of air before and after eating; appetite diminished; stool normal. Thin figure, complexion rather icteric, conjunctivae of a yellowish tinge. Nux vom. gave only temporary relief. Cholesterin, as above, removed the pain in a few days. On account of relapses the medicine had to be continued for eight weeks. The cure seems to be permanent.

Mr. Bohmer, sat. 40, slightly pot-bellied, has suffered for four years from anorexia, full feeling after eating, weakness, great irritability, emaciation, constipation for three days at a time, hemorrhoidal lumps. Left lobe of liver more sensitive than gastric region, no perceptible enlargement. Cholesterin °°4, five drops three times a day. After eighteen days the report was that the constipation, anorexia, and hsemorrhoids were all better. The medicine was repeated. No further report.

I acknowledge that the remedy in all these three cases is not very clearly indicated. "Liver more sensitive than gastric region" is a symptom depending on the subjectivity of the patient and physician. In spite of this indication I have found the remedy useless more than once. I hope to be able hereafter to say something more scientific on this subject.

In the following case the indication for the remedy was more precise:

Mr. Fliesbach, set. 48, of ordinary constitution, has suffered for two years from periodical pains in the hepatic region, unconnected with eating. Appetite good, no derangement of digestion, appearance good. At a hospital here a kidney affection was diagnosed, but the renal remedies administered were of no use. Several other physicians were equally unsuccessful. The pains extended to the right shoulder and sacral region, came in very violent fits, and were never attended by icterus. Examination showed great sensitiveness of the hepatic region with apparently normal size of that organ. The stomach was but little sensitive to pressure. Cholesterin °°4, five drops four times a day. My confidence in the remedy was justified, rapid improvement set in, and a cure was effected in eight weeks, which up to the present time, now half a year, was not disturbed by any relapse.

In the following case the accumulation of masses of Cholesterin (gall-stones) was well marked:

Mrs. Geres, set. 40, had suffered for half a year, after confinement from periodic extremely violent pains, occurring about every eight days. They begin as if a ball rose from the region of the uterus up to the stomach and back. This feeling was described as a violent burning, as from a hot iron. Along with this there is vomiting, and during the whole time great diminution of appetite. Uterus somewhat anteverted. After each attack the stool was white, and the urine dark-coloured for a short time. No great icterus. An allopathic treatment with Carlsbad salts and Oil of Turpentine made no apparent impression. Cholesterin °°3, O'l gramme twice a day. The following day there was a sharp attack, none afterwards. Two years afterwards I was informed that there had been no relapse. The remedy was continued for thirty-two days.

Lactic Acid, CgHgOj.

Chemists distinguish three modifications: lactic acid of fermentation, aethylin (flesh) lactic acid, paralactic acid, and hydracryl acid.

Of these the first three have hitherto been met with in the organism of. animals, the two first in the human organism. As the several forms are seldom indicated in literature, I shall not now make any distinction. The lactic acid of fermentation appears to be that most generally alluded to.

Occurs:

A. Physiologically.

In the gastric juice, in the contents of the small and large intestines, in the muscular substance of man, mammals, and some fish, in the juice of the contractile fibre cells, in ox-gall, spleen, liver, thymus, thyroid, pancreas, lung, brain. In the blood after prolonged muscular work. It is free only in the gastric juice and duodenum (?). (In sour milk.) The lactic acids are produced in the organism by a decomposition of sugar.

B. Pathologically.

Increased in the blood in leukaemia, pyaemia, puerperal fever, in the fluid of ovarian cysts, in purulent and other exudations. In the urine in rhachitis, osteo-malacea, leukaemia, trichinosis, phosphorus poisoning, acute atrophy of the liver. In the saliva in diabetes. In the sweat in puerperal fever. In osteo-inalaceous bones.

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