ered through the first stage, but in which such a large surface of lung tissue is involved that the breathing is extremely labored. Blood-letting and cardiac sedatives are worse than useless now, but we have, under these circumstances, a most useful agent in oxygen gas. It is a very powerful cardiac stimulant, and of course will allow the respiratory changes to take place even when the breathing surface is much diminished. No case in which it was employed has come under my own observation, but I am cognizant of one apparently hopeless case which was relieved by this agent when all other means had failed. In the third stage the indications are to keep up the strength of the patient, to promote the removal of the softened contents of the air-cells, and to aid in the restoration to the tissues of their natural tone. Quinine in small doses three or four times a day, a nutritious diet, and the use of stimulants are the best means which can be employed for this purpose. Other tonics also, such as iron, nux vomica, phosphorus, and cod-liver oil may often be used with advantage if the effused matter is slow in disappearing. It is in this stage that counter-irritants may often be used with signal benefit. An atonic condition of the blood vessels and other tissues of the lungs exists, which yields more promptly to tonics and counter irritants combined than to either class of agents when employed separately. Fresh air and exercise, so far as the strength will admit, are of the greatest service; indeed, it is important that the patient have an abundance of pure air throughout the whole course of the disease. MAY IODIDE OF POTASSIUM EXCITE BRIGHT'S DISEASE? By I. EDMONSON ATKINSON, M.D., MARYLAND. It WHERE opportunity is afforded of examining, after death, the bodies of persons who have suffered from late syphilis, an astonishingly large number of them will be found to present evidences of disease of the kidneys. In 24 autopsies of syphilitic subjects, Lancereaux observed renal degenerative changes eight times. Moxon discovered alterations in these organs in 14 out of 25 post-mortem examinations of syphilitics at Guy's Hospital. must be acknowledged, however, if we consider the whole number of persons who have had syphilis, the proportion who develop kidney disease is exceedingly small. Indeed, with very few exceptions, syphilis and kiduey disease would seem to exist in the relations of cause and effect, only amongst those unfortunates who experience the late or tertiary manifestations of the affection. Pathologists have long been aware that the diseased kidneys of syphilitic persons present differences as great in microscopic as in gross appearance; changes that may be encountered with equal, even with greater frequency, as results of other affections, as well as changes that are essentially syphilitic. Of the forms of disease of which I am now speaking, the most frequent, by far, is one that is not in itself syphilitic. This is lardaceous or albuminoid degeneration, and was first described as of syphilitic origin by Rayer,3 in 1840. All subsequent writers have remarked its frequency. Moxon, in the article already quoted, observed in his 27 autopsies, lardaceous degeneration of the kid 1 Gaz. Hebd., i. 1864, p. 502. 2 Guy's Hospital Reports, 1868, p. 329. neys 11 times. But the frequency of lardaceous disease, as the result of syphilis, may be more readily appreciated by studying the etiology of this form of degeneration. Thus, Fehr (quoted by Roberts) reported syphilis as present in 34 out of 145 cases of lardaceous kidney. Dickinson' compiled 83 cases of lardaceous disease from the dead-house reports of St. George's Hospital, the presence of syphilis being noted 18 times. This form, when of syphilitic origin, is identical with the same degeneration in persons free from the disease. It is true that some writers, Beer,2 more especially, describe peculiar conditions. and distributions of the process, to be met with only in syphilitics; but this lacks confirmation. On the other hand, there is a form of renal disease, quite characteristic of syphilis-the cir cumscribed interstitial inflammation known as gummy tumor. This is of exceedingly rare occurrence. Moxon found it but once in his 27 autopsies, while there were 16 cases of renal disIn Lancereaux's 24 autopsies, where diseased kidney was detected eight times, gummy tumors were met but once. Numerous cases of gumma of the kidney have been recorded, but the lesion is undoubtedly a rare one. From one to 20 may be encountered, and their size may vary from a mere point to the dimensions of "a small potato." It is stated, upon the autho rity of Beer, Moxon, and others, that purely parenchymatous nephritis may be dependent upon syphilis. It must be very infrequent. But there is still another form of renal alteration of syphilitic origin. ease. Generally diffused interstitial hyperplasia, and subsequent fibrosis of the kidneys, not associated with lardaceous disease, is rare in syphilitics, and yet it is not uncommon to find these organs, with circumscribed areas of interstitial hyperplasia, or of its cicatricial remains, distinct from ordinary gummy tumor. Just as one finds in other organs, notably, the liver, lungs, and testicle, syphilitic inflammations, not at all differing, in their appreciable morbid processes from simple inflammations; so, in the kidney we encounter diffused interstitial nephritis, which, except for a disposition to more circumscribed distribution, is like interstitial nephritis from other causes. Where the process involves the entire organ, there is no way of deciding upon its specific origin. More frequently, however, only a portion of the 1 Dis. of Kidneys, Part II. 1877, p. 473. 2 Die Eingeweide Syphilis, 1867. kidney is affected, and when considerable contraction has resulted from this form of interstitial disorder, it is often seamed with scars, which, from their circumscribed arrangement, are very characteristic. It is not unlikely that localized cicatrices may sometimes result from the absorption of gummy tumor. A considerable degree of fatty degeneration of the epithelia of the tubules often accompanies these processes. From the foregoing remarks it will be seen that, of the different alterations to which the kidneys of syphilitics are liable, but one can be regarded as certainly syphilitic, the gummy tumor, the most rare of all. Diffused nephritis can only be recognized as probably syphilitic, when of limited and circumscribed extent. On the other hand, lardaceous degeneration, most often observed, is only a result of syphilis, as it is a result of tubercle, of scrofula, of prolonged suppuration. Now, while it is certain that we may have these forms of disease due to syphilis, it by no means follows that disease of the kidneys in syphilitics is always of syphilitic origin. May it not arise from adventitious causes more often than is generally supposed? It is evident that, apart from any influence that syphilis may exert in renal pathology, the kidneys of syphilitics are just as subject to morbific influences as those of healthy people, and that one should not necessarily attribute to this disease lesions that are not characteristically specific. One occasionally finds in medical literature statements that albuminuria and nephritic inflammation have been known to arise in consequence of the ingestion of the iodide of potassium. These reports, it is true, are few in number, and quite vague in character, and yet they come from sources that entitle them to respectful consideration. Thus, Van Buren and Keyes' state that it will sometimes happen "that patients with visceral syphilis, under protracted treatment, by large doses of iodide of potassium, will gradually show morning nausea, and upon examination their urine will be found light, slightly albuminous, and containing pale casts. In such cases, the kidney trouble is probably due to the irritation produced by the large amount of iodide of potassium passing through them, and the albumen and casts may be made to disappear, together with the morning nausea, by reducing the activity of the treatment. Several such 1 Genito-urinary Diseases with Syph., p. 380. |