In order to be able to make an exact diagnosis, it is necessary to examine carefully, both the urea and the other excreta, for several days consecutively. As a rule, persons attacked by simple polyuria, or who are suffering from interstitial nephritis, beginning with polyuria, do not present the symptoms which we have enumerated.
Disturbances of the nervous symptom and alcoholism claim the first place in the etiology of this affection, and indicate the treatment which has to be adopted. It consists in administering drugs to calm the nervous erethism (opium and valerian), and to put a stop to the excessive and progressive impoverishment of the tissues (arsenic, a suitable diet, etc.) Valerian has proved specially successful in different cases, even effecting a complete cure. Besides these cases of azoturia, combined with polydipsia, Bouchard thought that there was another form of the same disease, in which there was no abnormal excretion of urine, although the latter contained an excessive amount of urea. However, as his observations in that respect are far from being satisfactory, and as these are evidently cases of cachexia, the etiology of which is very obscure, it will be wiser to leave them alone for the present. The author then goes on to consider the much-debated question on the varying amount of urea in glycosuria. In some patients suffering from the latter affection, as much urea is eliminated as the general amount in azoturic patients. It is true, however, that there may be something more than a simple coincidence between these two affections, and several authors have tried to link them together. Lécorché, who admits the hepatic theory of the formation of urea, thinks that this is only the double result of hyper-activity of the functions of the liver. Bouchard, on the contrary, considers it as a true complication of the existing affection, where troubles of nutrition are added to those resulting from insufficient respiratory combustion. According to him, the difference between melitæmia and azotæmia consists in the first resulting from the accumulation of a product of secretion, while the second results from the accumulation of a product of secretion. Azoturia is, therefore, as we said, only a complication, an accessory element which must, however, be considered as being a most important prognostic symptom. According to the same author the abundance of sugar in diabetes is owing more to a want of combustion than an exaggerated production of this substance in the organisms. If this be the case, how can we explain the coincidence of an abnormally low temperature with the production of an exaggerated quantity of urea, such as has been observed in every case without exception? This is the weak point of M. Bouchard’s theory, and it would perhaps be better to refrain from giving a decided opinion on the subject until it has been more thoroughly studied. In short, whenever there is an excessive excretion of urea we may consider it as a symptom of incipient cachexia, followed by loss of flesh. The most important question, however, for the medical practitioner is the following: are these two affections to be considered as belonging to two different groups, but having been developed incidentally at the same time in the same patient; or are they connected through a link which is still unknown to us, thereby forming one affection or disease? If these questions could be solved, there might be some hope of discovering some rational mode of treatment, so as to prevent albuminuria from setting in, in which case all is lost. In another chapter we find the calculation of the amount of urea excreted in several chronic diseases, such as obesity, syphilis and athrepsy. Here it is easy to make a mistake, and still more so to err in trying to interpret the results obtained, because here the nourishment taken by the patient plays an important part, which is easily overlooked, e. g., in fleshy persons. Azoturia may be produced either by excess of food, or by abstaining from farinaceous food. The only way of ascertaining if the combustive functions are really exaggerated in a patient would be to compare the amount of chlorates contained in the secretions with the weight of the patient. Since Brouardel published his paper, on what he termed the uropoietic functions of the liver, several experiments have been made to ascertain the amount of urea excreted in diseases of this organ. The results have been very contradictory, but it is certain that large quantities of urea have been found in the urine of patients whose liver was completely degenerated.—London Medical Record.
EXPERIMENTS CONCERNING ERYSIPELAS.
Observations “were undertaken” by H. Fillman, of Leipzig, “in order, if possible to obtain further and more accurate information upon some contested points regarding erysipelas.” The experimenter has addressed himself here, especially to the answering of the four following questions:
I. Is it possible to convey erysipelas by inoculation from a diseased to a healthy individual? In other words, do those fluids obtained from the tissues of an erysipelatous part and employed for inoculation (e. g., lymph, blood, the contents of bullæ, pus, etc.,) exercise a specific, i. e., contagious action on healthy individuals when inoculated, or do they not?
II. What is the action of carbolic acid upon those erysipelatous animal fluids which produced the same disease on being inoculated into healthy individuals, and therefore in all probability contained the erysipelas poison?
III. In what way is it possible (apart from direct conveyance) to produce erysipelas in healthy animals by the application of different morbid matters?
IV. What do we learn from the results of anatomical and experimental investigation regarding the presence and significance of bacteria? What relation have they to erysipelas?
It would be difficult for four more interesting or important questions for the practical and scientific surgeon than these. But in proportion to their importance are the difficulties which surround them. These, however, are grappled with by the author courageously, patiently, and honestly, and the result is at all events a series of experiments of extreme interest, whatever be the conclusion, we may feel disposed to draw from them. Indeed, the writer himself seems to have set out upon his investigation purely with the desire to learn whatever is to be learned on the points stated, by careful and patient anatomical research, and without being wedded to any particular theory in regard to them, or desiring to force any conclusion.
Recognizing the great importance of the subject, and the efforts that have been made by others in the same direction to throw light upon it, notably by William, Ponfick, Orth, Bellien, Zuelzer, and Lukomsky, he has recognized many points in which these observers have failed, and has endeavored, in following out somewhat similar lines of research, to avoid their, and other, errors.