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dermically. Rhus. 3x, apomorphia 3x (for the vomiting), and arsenic 3x, were used intercurrently with the renal stimulant upon special indications. Cantharis was continued after the convulsions for three days, when tenesmus and irritability of the bladder appearing, it was discontinued in the stronger form and a 3x dilution substituted for a week, when a return was made to the tincture, in connection with merc. corr. 3x. Beginning about April ist, treatment with chloride of gold, xv. gtt. t. i. d., in water (one-half of one per cent. alcoholic sol.) was entered upon and continued uninterruptedly up to the present writing. The urine during April, May and June was examined repeatedly. But two or three times could a trace of albumin be found only with the centrifuge and after most patient search were a few small granular casts discovered. The twenty-four hours' excretion ranged from 50 to 70 ounces—the specific gravity from 1007 to 1012 and the urea from 1 to 3 grains per ounce--approximately an average of 120 grains a day with the patient on a mixed diet. During this nine months the patient has steadily progressed to health, weighs to-day 150 pounds, and considers herself well. The final analysis of urine was made October 15th; total quantity, 60 ounces; specific gravity, 1010; urea, 43 grains per ounce; no albumin; no casts.
From the point of view of the urinologist, this case will repay reflection in at least two directions; that of the pathogenesis of uremia, and that of drug influence upon certain renal conditions.
Two diametrically opposed phenomena have undoubtedly struck the reader. First, that the uremia succeeding the operatior. appeared, continued and increased, during the space of five days, with a total daily elimination of urea at and above the normal amount.
Second, that in the months since that nearly fatal 6th of March, the total amount of urea thrown out through the urine has been for weeks continuously less than one-fifth of the healthy standard, the patient being on a full diet, with absolutely no toxemia. The results in the latter case were so unusual in my experience that the urea tests were many times repeated by myself and by Dr. Bliss for verification, but the other four-fifths of the normal amount of urea or any portion of it, could not be found. No one, of course, nowadays, considers that retained urea produces uremia. At least he should not if he recollects, among other things, that experiment has proven that one pound Troy of urea retained at one time in
the body, is demanded to kill a man of 130 pounds weight; in other words, that he should remain nineteen days without eliminating a single grain of urea. While recognizing that other substances besides urea are responsible for uremic intoxication, we have nevertheless clung to urea as an indicator of the permeability of the kidneys and as an index of the degree of toxemia present or about to occur. We may be forced from this position eventually-for nearly a week this indicator announced that the kidneys were doing their required quota of work, yet intoxication was all the while present and deepening, and the urea began to diminish only when the uremic condition was well advanced. Looking at the case from the other standpoint, the diametrically opposite one, the prospect is even more disconcerting. For we have a woman on a full diet, practically in possession of her wonted strength and habit, eliminating repeatedly but 60 grains of urea in the twenty-four hours, not one-third of the amount disposed of on the day preceding the convulsions, and less than one-quarter of the daily elimination when the woman's vertigo first led to an inspection of the urine.
Does the elimination of urea indicate something or nothing, then, in renal deficiency? Why should it tell one story in one phase of a nephritis, and a widely different one in another?
Cantharis tincture is unquestionably a renal remedy of decided value, but probably as yet rather vague in its sphere of adaptability. Dr. Macdonald has found it of immense value in post-operative nephritis; in one case in particular relapses occurring three times after as many attempts to withdraw the remedy. Dr. Goodno teaches its “superlative value for acute, sub-acute, and chronic diffuse nephritis.” Dr. Hare believes that it aggravates acute cases, and that “in the later stages, when the kidneys are relaxed and torpid, or when albuminuria comes on on the slightest exertion. . and in cases of chronic nephritis, particularly when alcoholism is the cause of the disease, and the kidneys are inactive, cantharidal tincture is very useful.” When the pathology of renal lesions has been fitted more clearly and certainly to the symptomatology, it may be possible to reconcile these apparently divergent opinions. If, for example, it is true that as Delafield claims, there are four more. or less distinct varieties of acute nephritis, one drug may be the Proper remedy in one condition, and a very unsatisfactory one in another. In the case cited the kidneys apparently failed to respond to its stimulus until after the convulsions, when it seemed to have found its sphere, thus complying somewhat with the suggestion
of Dr. Hare, based on his experience, that its usefulness is not early in the acute attacks, but after the lapse of some days.
The chloride of gold was probably first prominently prescribed as a renal remedy by Bartholow. Its action is thought to be upon the connective tissue elements, lessening or preventing their overgrowth, hence specially indicated in interstitial nephritis (chronic productive nephritis without exudation-Delafield). It is perhaps possible to claim for the gold the credit in this case, for the phenomena of low percentage of urea and coincident absence of toxemia, and increasing health. In "auric fever” profuse sweats and increased salivary secretion are noticed; both legitimate channels for the elimination of urea. May not some slight stimulation of these functions have existed in this case carrying off thereby imperceptibly, some of the waste product unaccounted for in the urinary estimates?
EUGENE H. PORTER, A.M., M.D.
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SECTARIANISM IN MEDICINE.
pends almost entirely upon the attitude of the allopathic school. The responsibility for divisions in the medical profession rests upon the allopathic majority and not upon the homepathic minority. Since the time of Hahnemann 90 homepathic physician has ever been admitted to an allopathic medical society unless he publicly abjured Homæopathy and all its works, nor has any discussion of the principles of Honæopathy, or any reportofcases treated according to the law of similia, been allowed, or any honest and unprejudiced attempt been made to ascertain the truth or falsity of the law. A century ago Homæopathy, tried and condemned without a hearing, was cast into the outer darkness; the brazen doors of Allopathy were closed against her and they remain barred and bolted to this day.
That which was ostracism and deprivation then has become merely a question of separation now. The new school seeks now no favors and asks but a fair field. It has risen from an humble and insignificant faction to a great and poweriul school of medicine, thoroughly equipped at all points
, pushing rapidly forward and sending out educated and cultured physicians the equals of those to be found in any school. If hostilities are to continue Homeopathy is and will
remain on a war footing.
But is there to be always war? Shall there forever be no peace? Is prejudice, that child of ignorance, to reign eternally? These are questions the answers to which must be supplied by the allopathic school. We cannot unbar their doors nor invite ourselves to enter through them. As they have erected the barrier, they must take it down. And here we come to the point at issue. Here and there we find individual members of the old school advocating greater tolerance and union of the schools. Some of our own school have also essayed to become apostles of sweetness and light. And it is doubtless true that there is a growing feeling ofdissatisfaction among the more liberal minded at the dissensions in the profession. The Allopaths have modified their practice and approached perceptibly in the use of parvules and tablets, homeopathic methods of dosage. 'The Homeopaths have recognized that the true physician is he who adds to his general knowledge of medicine, a knowledge of homeopathic therapeutics. But all this is mere surface play: the vital questions at issue are untouched and union is no nearer. Abnegators and nondescript journals may preach a spurious peace, but there can be no peace until the articles of agreement are honorable to all. Invitations to abnegation are offensive and may be accepted only by renegades. Does any man of sense believe that the homæopathic school would abnegate its principles, deny the truth of similia, submit to repression in practice and speech, simply to have the distinguished honor of sitting on the back benches of the Allopaths? No one but sophomores of the first water would indulge in such senseless fancies, and yet that is the plan gravely proposed in the name of progress, by a nondescript journal. When we are invited to join the allopathic societies without agreements of any kind regarding practice, when we are accorded liberty of opinion, liberty of discussion and liberty of action, then and not till then, will union of the schools become possible. As Professor Gardner of Glasgow said, “No one has a title to say to any one else, I insist that you believe so and so or I will disown you as a professional brother." When the Allopaths master this truth and apply it the medical millennium will be at hand.