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URINARY ANALYSIS AS A MEANS OF DIAGNOSIS. READ BEFORE THE ALLEGANY COUNTY MEDICAL SOCIETY AT ITS ANNUAL MEETING IN
FROSTBURG, MD., JUNE 6, 1895.
Cumberland, Md. NOTHING original is offered as the an electric centrifuge, which allows of excuse for speaking on the subject of the immediate sedimentation of the urinary analysis, but merely a desire to urine, and its examination before any awaken an interest in the importance of chemical change has taken place. Conit as a means of diagnosis. We are too ical tubes are used and after centrifugal apt in the hurry and cares of profes. action has been employed the amount of sional work to be satisfied with hurried sediment can be determined by a graduand incomplete diagnoses of our cases, ated scale on the tube. Precipitation and to treat them empirically. This of the substances in solution in the ought not to be when we have at our urine may be accomplished by the use command a means of finding out the of chemical agents, and the amount of true nature of the disease and applying substance determined by measure. Exsuitable remedies. Chemical analy. aminations made during a
course of sis and microscopic examination have treatment will aid materially in deterthrown a brilliant flood of light on hith- mining the progress of the disease. erto obscure diseases and have given to The diazo test was suggested by Ehrus a window, as it were, through which lich in 1882 as a diagnostic measure in we can see the interior of the body, and typhoid fever. The reaction depends determine accurately in many instances upon the fact that if sulphanilic acid be the seat of disease, its progress, and the acted upon by nitrous acid (HNO,), exact condition of the diseased organ. diazosulphobenzol is formed, which The examination of the urine need not unites with aromatic substances frebe confined to diseases of the kidneys quently found in the urine to form aniand bladder, but may be found service line colors. In this case a carmine red able in many other affections.
color is formed. This reaction is usuThe urine being one of the excretory ally found in typhoid fever from the products of the body may contain in fourth to seventh day and afterward. solution substances which, when ex If entirely absent the diagnosis is doubtamined chemically or microscopically, ful. The reaction has been noted in will show organic changes in organs not pulmonary phthisis of a rapidly fatal directly connected with the urinary sys type. It is always absent in chlorosis, tem, and thus afford an opportunity for hydremia, diabetes, diseases of the a correct diagnosis of the case, and more brain, spinal cord, kidneys and liver. rational treatment.
The urine in scarlet fever assumes the The methods of determining the spe febrile condition more or less marked in cific gravity, the tests for albumen, proportion to the degree of fever. Dur. sugar, etc., are of course familiar to all ing the first week the amount is less, of you, and need not occupy more space. and urea and uric acid increased, the Formerly urine was allowed to stand in chlorides reduced. About the sixth to a vessel some time in order that the eighth day if the disease proceed toward sediment might be obtained for exami a favorable termination the urine benation. This was unsatisfactory, as comes abundant, pale in color and apchanges would take place in the urine, proaches the normal standard. It should and render its examination almost use be examined both chemically and microless. To obviate this difficulty Dr. scopically to determine the progress of Charles Purdy of Chicago has devised the fever. Recent observations show
that nephritis exists almost as constant amount. Renal casts are seen, and ly as the rash or angina. Albumen ap sometimes free from pyelitis associated pears about the the fifth to eighth day, with the disease. subsiding about the fifteenth if the dis The general pyrexial characters of the ease proceed favorably. The amount urine are well marked in pneumonia. varies very much, sometimes mere The quantity is lessened one-half, but traces, in others the urine becomes al urea and uric acid are increased in most a solid mass when heated. Casts amount, especialiy on the so-called critare found if carefully looked for in most ical days. The increase of pigment is cases, the hyaline in favorable cases, often two or three times the normal epithelial, bloody and granular if ne range. phritis becomes established.
The chlorides are greatly diminished During the algid stage of cholera the or entirely absent during the first stage urine is more or less suppressed, due to of the disease. When absent later in collapse, and in part to exudation into the disease there is danger of a fatal the renal tubules, and thickened blood. termination. After the cold stage the volume slowly Albumen is present in about 45 per increases or is entirely suppressed, death cent. of all cases, and if in large quanrapidly following. The specific gravity tity it may be looked upon as an unfaof the urine upon reappearing is below vorable symptom. Nephritis may be normal, 1006-1008, and gradually rises latent in pneumonia, only to be disto normal during convalescence. Urea covered some weeks or months after conis much diminished, sometimes entirely valescence. absent during the first day. The prog In organic diseases of the stomach nosis may be considered favorable in the urine contains a considerable quanproportion to the amount of urea ex tity of peptone. This is especially true creted in cases which have passed the where there are ulcerative changes. algid stage. The phosphates and chlo A mild form of albuminuria is frerides are absent or in small amount at quently present in disorders of the stomfirst. The normal urinary pigments are ach, and examinations in these cases nearly entirely absent during first two will show no casts. Small quantities of days, returning later. Indican is pres- sugar are found in a number of stomach ent in marked quantities and prior to affections. Amorphous phosphates and the discovery of the cholera bacillus was calcium oxylate crystals are most freconsidered the most important diagnos- quently found in the urinary sediments tic sign of cholera. The first urine in of dyspeptic subjects. cholera almost always contains albumen, In yellow fever the urine is diminbut as a rule the albuminuria is of short ished, frequently suppressed, when the duration. It sometimes persists, how- symptoms of uremia follow. The reacever, and death may result from uremic tion is first acid, becoming alkaline durcoma. Renal casts and large deposits ing convalescence. Its color varies from of epithelium are invariably found. Fre a bright-yellow to greenish - brown or quently blood corpuscles and uric acid black, or it may be red from the presence crystals are also found.
of blood. It is almost always albumiIn diphtheria the urine is much less in nous. Urea is lessened, sometimes enamount than normal, of high specific tirely absent. This is also true of the gravity, and acid in reaction. Uric acid uric acid. is copious; amorphous urates, oxalates The most noted change in the urine and sometimes phosphates are found in in typhoid fever is the diminished the deposit. Albumen is present in amounts of chlorides ; in severe cases 50 per cent. of cases, sometimes in they are entirely absent, or not excreted. large amount. The kidneys become af. This is not due to lack of food, or diarfected in some cases, but not so fre- rhea, but seems a constant feature of the quently as in scarlatina. The quantity disease, thus furnishing another diagof urea is nearly double the normal nostic sign for this malady.
Cirrhosis of the liver is marked by a cases, assists in determining whether the constantly lessened flow of urine; so case is one of obstructive or non-obstrucmarked is this fact, that a constant copi- tive jaundice. ous flow would be strong evidence of the Acute yellow atrophy of the liver.absence of cirrhosis. The urine is dark. This rather rare but rapidly fatal disred, brown or even blackish. The acidity ease is marked by pronounced jaundice, is increased and it becomes still more acid and great destruction of hepatic cells. on standing. So constant is the associ The urine contains both bile acids and ation of bile pigment in the urine in this bile pigments and is strongly acid. The affection that it may serve to distinguish amount is much diminished, though not ascites of hepatic origin from that of suppressed, and the color is very dark peritoneal effusion.
brown. Urea is lessened, sometimes Albuminuria is rare except when as nearly absent, uric acid and phosphates sociated with valvular heart lesions. are reduced in quantity. Casts, when The urinary sediment does not contain present, often appear yellow from stainrenal casts.
ing with bile pigment. As a rule, the volume of urine is some The most noticeable urinary change what lessened in jaundice, uric acid is in gout is the deficiency of uric acid, increased and urea diminished. It is and the presence of small, narrow hyahighly acid, becoming more so upon line casts and crystals of calcium oxastanding. The color, due to bile pig- late. In acute rheumatism the increase ment, varies from a saffron-yellow to of the sulphates in the urine is greater a greenish-brown. Where sugar is pres than in any of the acute fevers. ent the case is unfavorable for recovery. In closing, gentlemen, let me say that The value of urinary examination in in my effort not to be tiresome I have this affection is to establish the diagno- avoided formulae and detailed methods sis promptly, which may be readily done of testing urine, as my purpose has been as the bile pigments are present in the not to give information, but rather to urine early. The presence of bile pig- awaken a greater interest in the subject ments, or their absence in doubtful of urinary analysis.
THE NECESSITY OF ISOLATION AND ADVERTISEMENT OF CERTAIN CONTAGIOUS AND INFECTIOUS DISEASES. READ BEFORE THE STATE MEDICAL SOCIETY OF PENNSYLVANIA, JUNE 9, 1895.
By F. Le Moyne, M. D.,
Pittsburgh, Pa. CONTAGIOUS and infectious diseases But by the general introduction of vacciproduce a large proportion of the suffer pation, its ravages have been so restricting and death to which the human race ed that it is no longer a reasonable is subjected. Medical science has ac source of dread. complished great results in mitigating Those who have witnessed and exthose evils, and it may be confidently perienced the desperate helplessness of expected that the glorious work of im the diphtheritic victim have the unmunization and antidotal treatment, speakable gratification, in this, the inwhich is fortunately exciting the inter- fancy of the antitoxine method of treatest and enthusiasm of medical scientists ment, of being able to reduce the in the leading countries of the world, mortality in desperate cases of diphthewill produce additional advantages equal, ria at least fifty per cent. of their former if not superior, to those which have death rate, with a prospect of better already been attained.
results from the perfected methods which One hundred years ago smallpox was will surely follow more matured exa scourge almost as horrible as war. perience.
All contagious and infectious diseases fully isolated and plainly placarded is should be treated as preventable by im a shameful menace to the surrounding munization and isolation.
population. Immunization is known to be effec Existing laws in this State commit tual by natural methods in a consider the strange inconsistency of exacting able proportion of such affections, and precautions and restrictions in regard to enough has been accomplished in its smallpox, which is to a great extent scientific application to lead to the be under control by vaccination, and from lief that it is practicable in all.
which disability and mortality are comPerfect isolation is impossible, be- paratively inconsiderable, while scarlacause the most susceptible subjects will tina and diphtheria, to which a much be impressed by very remote influences. larger proportion of the population is But that fact does not justify the ex susceptible and in which the death rates posure of the whole susceptible commu are very high, have every opportunity nity by unisolated cases.
for dissemination and are not subject to Every center of population should be legal regulations. provided with hospitals for contagious Fortunately this subject is under diseases, and laws should be enacted wise consideration by the Legislature of which would provide for the removal Pennsylvania now in session. An act thereto of every case of dangerous con has been framed which although not all tagious disease, for which reasonable that we could desire, has much to recomisolation is impracticable in its existing mend it, and I hope that it will meet location.
with the approval and support of every The members of the medical profes- member of this society. It has passed sion are the natural and acknowledged the House of Representatives and it is guardians of the health of the people, reported by good authority that it will and it is incumbent upon them to lead be favorably considered by the Senate. the public mind safely in that direction. I offer, herewith, a copy of the bill for We should emphasize the fact that every the information of those who may not case of scarlatina or diphtheria not care be familiar with it.
Pelvic ABSCESS COMMUNICATING WITH more feces escaped through the vagina. INTESTINE. · Marx ( British Medical" Much Auid had to be thrown up the recJournal ) records an operation on tum before any of it returned through woman, aged 44, long subject to symp the vagina, hence the communication toms of pelvic inflammation. She had must have been high up. It could not, not been pregnant for eighteen years. however, be detected by the finger On December 8, 1894, there was exten passed into the abscess cavity. By Febsive parametric deposit, with indistinct ruary 18, 1895, the patient was in good fluctuation in the left iliac fossa. By health. A little pus still escaped from December 17 this Auctuation had be the vagina, but all pain had disappeared. come quite distinct ; the pain was intolerable. On the next day vaginal hys VASCULAR SPASM WITH CARDIAC DI. terectomy was performed. Large ab. LATATION.-J. Jacob (Medicine) says: scesses were then laid open. The ap "A sudden spasm of the peripheral vespendages could not be removed. One sels occurs with a chill and sometimes very large collection of pus was opened pain, precordial distress, dyspnea, cold on Hilton's method. About a pint es skin, and very slow or very rapid pulse; caped. It was bluish, and smelt fecal, at the same time there is acute dilatabut no fecal matter was found in it. A tion of the heart, the area of dullness is T-shaped drainage tube was placed in increased, and the apex is displaced. its cavity. On the tenth day a quantity This continues for several weeks, or inof feces was found in the vagina. For a definitely if the attacks are recurrent. fortnight motions passed both ways; The best treatment is hypodermic inwhen there were scybala in the rectum jections of full doses of morphia."
present seemed to enjoy himself and to appreciate fully the kindness of the phy. sicians of Frostburg.
E. T. Duke, M. D.,
ALLEGANY COUNTY MEDICAL
ANNUAL MEETING JUNE 6, 1895.
The Doctor's LIFE AND WORK.A large number of physicians were At St. Mungo's College, London, on present. Promptly at 2 o'clock Dr. A. Saturday, June 29, Dr. D. C. McVail deG. Smith called the meeting to order. livered the closing address, as reported About ten or twelve new members were in the British Medical Journal, to the elected. Dr. W.Q. Skilling read a paper
students in the rooms of the Medicoon The IMPORTANCE OF EARLY INCISION Chirurgical Society. He said there was IN TREATMENT OF OSTEO-MYELITIS. no enormous difference between men enDrs. Carpenter, Cromwell, J. M. Price, gaged in the ordinary work of life and a Jacobs and others took part in the dis true and genuine member of the medical cussion.
profession, except that his best work Dr. E. T. Duke followed with a paper was done among those from whom he on URINARY ANALYSIS AS A MEANS OF could expect no reward, and sometimes DIAGNOSIS. (See page 291.) The fol not even gratitude. In that respect the lowing officers were elected for the en medical profession resembled the Church, suing year : Dr. A. G. Smith, Presi. but its work entailed far more labor and dent, Drs. Boucher, Spear and Jacobs, self-sacrifice. The true doctor was an Vice-Presidents, Dr. F. W. Fochtman, unpaid medical missionary. The merSecretary, and Dr. W.J. Craigen, Treas- chant, the manufacturer and the engiurer. The afternoon session then closed neer were as well educated, though on and the Society proceeded to the St. different lines, as the medical man ; but Cloud Hotel, where they were hand they differed in this, that the best of somely entertained by the physicians of the medical work was given to the poor Frostburg
as though they were rich. Government At 8 P. M. the Society was again called payments to medical men were a mere and opened by Dr. C. C. Jacobs with an fraction of the market price of the work able paper on THE TREATMENT OF that the profession had to do. Though STRANGULATED HERNIA. Discussion the medical man seemed to live a public followed, participated in by Drs. Spear, life, the nature of his duties made him Cromwell, Boucher, Price, Smith® and probably the most solitary man in his others.
village, carrying secrets of importance, Dr. Carpenter, on behalf of the phy- and knowing oftentimes conditions of sicians of Cumberland, gave a full state life and health which he must keep ment of the differences which have ex locked up against his most unguarded isted between the physicians of this city moments. His duty lay with his own and the Board of Managers of the West conscience alone. His patients could not ern Maryland Hospital. These difficul- judge of his failures or of his triumphs. ties have been adjusted and the physi. The public could not estimate his work cians of the county and adjoining neigh as they could that of a clergyman or a borhood are invited to send their patients lawyer. The doctor's work, so far as to the Hospital. Cumberland was se. the patient was concerned, was written lected as the next meeting place, and in water. Work of this solitary type Drs. Porter, White, Cromwell and J. was fraught with grave temptations and M. Price were selected to read papers. dangers to the medical man. The meeting closed with the President's should he continue to be the plodding, address, PHYSICAL Culture. Everyone hard-working student, watching the ad