A system of practical medicine. By American authors. Vol. 4

by Unknown

The PROGNOSIS is usually favorable. Very rarely is an attack fatal, and when such is the case it is from exhaustion—from the drain to which the system is subject. Tubercular phthisis is therefore a not infrequent immediate cause of death.

TREATMENT.—On the supposition that filariæ are the essential cause of the disease, the rational indication would be first to destroy them by the introduction into the blood of some parasiticide; and, second, to repair the lesion of communication between the lymphatic system and the urinary passages. As yet no agent is known which would not be as fatal to the host as to the filaria, if used in sufficient quantity to destroy the latter; nor has it ever been possible to find the point of communication between the two systems, although treatment has been directed to producing closure of such communication, and with some show of success. Thus, in a case under his care Dickinson of London injected into the empty bladder twelve ounces of a solution of perchloride of iron, containing at first two drachms of the tincture to the whole quantity, gradually increased to four drachms. The solution was retained in the bladder for from eight to twelve minutes with little or no inconvenience. The operation was repeated almost daily for twelve days. The effect was always to check the milky flow and to substitute a clear urine. But after the operation had been repeated a certain number of times there was a decided rise of temperature, with headache, nausea, lumbar pain, hæmaturia, and albuminuria which continued a short time after the hæmaturia ceased. Singularly, too, with the subsidence of these symptoms, the chyluria remained absent for some time. The injections were resumed on its return, and each time were followed by relief. In the course of their use, however, the strength of the solution was increased to an ounce of the perchloride to twelve ounces of water, and the strongest solutions were retained in the bladder for as much as an hour, the weaker longer. Ultimately, however, the use of the injections became so painful that they had to be discontinued.

Another measure, employed by Bence Jones, was abdominal pressure by means of a belt. This also, in his experience, relieved the lumbar pain. In his case, which was about eight years under observation, Dickinson applied the pressure by a sort of tourniquet about an inch below the umbilicus. This lessened, though it did not stop, the pulsation in the femoral arteries. It also was successful at first, the chylosity lessening, and finally ceasing, but on the removal of the belt the chylous character gradually returned, and in sixteen hours was as bad as before. Repeated trials were followed by the same transient effect, but no cure. Under this treatment, however, combined with a liberal diet and rest, the patient gained many pounds in weight, and was able to leave the hospital and resume her occupation as dressmaker, the pursuit of which, and the absence of the favorable conditions of hospital-life, as invariably caused a return of the symptom and its resulting debility, which again caused her to seek admission.

Rest, therefore, and an abundance of good nourishing food, tend at least to counteract the exhausting effects of the disease, and even to cause the discharge to cease. Tonics, and especially chalybeates, are indicated for the former purpose.

As the relaxing effects of warm climates and warm weather seem to predispose to the condition and to aggravate it, removal to cooler latitudes and places is indicated.

Astringents, internally administered, naturally suggested themselves at an early date, and were used by Prout, Priestley, and Bence Jones. The latter especially thought gallic acid useful. He reports a case in which the disease did not return after its long-continued use. Goodwin of Norwich, England, also reports a case in which the chyluria was controlled by the gallic acid, but returned in four or five days after the remedy was discontinued. It again disappeared on resuming the drug, and the patient could at any time render the urine nearly normal in appearance by taking it. The case was lost sight of before it could be regarded as cured. Waters also reports a case which apparently recovered completely after nine weeks' treatment by gallic acid. He gave at first 30 grains a day, which were gradually increased to 135 a day, and then gradually reduced.

Other astringents which have been used are tannic acid, matico, or acetate of lead, nitrate of silver, the mineral acids.

Mangrove was successfully used in a case related by Bunyan of British Guiana. It was used in the shape of a decoction at the suggestion of a negress, an ounce being taken four times a day. In seven days the patient was so much relieved that the remedy was discontinued for two days, but the symptoms returned. They again disappeared when the drug was resumed, and two subsequent attacks were immediately cut short by the remedy. Roberts suggests that it may act as a parasiticide, and suggests larger and sustained doses of the iodide of potassium for the same purpose.

Retention of urine, when present, should be treated like the same symptoms under other circumstances, by catheterization, washing out the bladder with tepid water, warm fomentations, and similar measures. It has even been suggested to wash out the bladder with ether under these circumstances.

As it seems impossible for the embryo filariæ to develop in the human body into the fully-developed Filaria Bancrofti, it is evident that with the death of the latter, which must occur sooner or later, the production of embryos must cease, while those previously produced must sooner or later also die, and in this way a spontaneous cure take place—just as a person infested with trichinous disease will ultimately recover if the introduction of the trichinæ cease and he is able to survive the irritation caused by the presence of the parasite in his muscles. In this manner we may account for the spontaneous disappearance of the disease in so many instances where all treatment has proved unavailing.