Page images

effect upon the disease. Of these nine four died, three from coma and the fourth from general weakness. In six other cases there was no information as to the type of diabetes present, but all recovered. He recommends that the following precautions should be taken before and during the operation; he would diet them previously, and administer large doses of bi-carbonate of soda; he prefers to operate early in the morning and to make the anesthesia as short as possible.

JAMES W. ALLAN. "On the Transplantation of the Pancreas as a Remedy for Diabetes." Lancet, May 14th, 1904.

After pointing out the experimental grounds upon which such an operation might be advocated, Mr. Allan refers to two cases, one at Bristol and the other in Glasgow, in which the attempt was made unsuccessfully. He thinks it might be tried with a fair prospect of success, but the conditions he lays down are (1) that the case does not respond to dietetic or drug treatment, and is drifting within range of diabetic coma; (2) that the patient consents; (3) that acetonuria is not present, and (4) that a sheep shall be freshly killed close to the place of operation and its pancreas directly conveyed to the body of the patient.

Note. These conditions would be somewhat hard to fulfil, as acetonuria is almost invariably present in cases drifting withia range of diabetic coma, and which do not respond to drugs or diet.


"Influence of Drugs on the Excretion of Sugar in Diabetes." Zeitschr. für klin. Med., 1903, Vol. XLVIII.

Kaufmann has examined a large number of remedies alleged to possess some power over the excretion of sugar, but with little result. Those only which exert any influence are opium, salicylic acid and its derivatives, salol and aspirin, and in some degree jambul extract. In severe cases opium alone is useful.

A. POPOV. "Diabetes Insipidus in the Child." La Semaine Medicale, 1903, p. 308.

This paper analyses twelve cases, of which nine occurred in boys and three in girls, five of the cases occurring between the ages of one and five, and seven between the ages of five and fourteen. In six there were neuropathic antecedents in the families of the patients, and in two there had been injuries to the head. The average duration of the disease was six years. The treatment consisted in the employment of narcotics, and antispasmodics such as belladonna, valerian, and antipyrin. According to the experience of Kuelz and Goundobine, warm baths and the constant current also gave very good results. A complete cure was, however, rarely obtained; of the twelve cases analysed only four were permanently benefited by treatment, the other eight being apparently unaffected by it


"Researches on a Case of Diabetes Insipidus." Zeitsch. f. klin. Med., XLIX., 1-4. La Semaine Medicale, 1903. p. 315.

This paper is based upon a study of the effects of diet on a man, aged 41, under treatment in the hospital at Helsingfors for diabetes insipidus. The author found that on a diet free from albuminous substances the total urine fell from 7 to 3 litres daily, and the general condition improved, the thirst being notably lessened; when this diet was replaced by one rich in albuminoids the polyuria and other symptoms returned. The modified diet seemed to have no effect on the composition of the urine, so that the author concludes the disease to be dependent upon a functional trouble of the kidneys, in which the substances to be eliminated can only pass when dissolved in a large quantity of liquid; as an albuminous diet gives rise to a large amount of solids to be excreted by the kidneys, polyuria follows necessarily. The use of large quantities of chloride of sodium led to a similar result. The author therefore recommends the treatment of diabetes insipidus by a diet poor in albuminoids and chlorides. The diet employed by him

consisted of: bread 100 grammes, butter 150 grammes, mashed potatoes 500 grammes, apple sauce 200 grammes, sugar 75 grammes, cream 50 grammes, beer 600 grammes, tea 250 grammes, the whole corresponding to 4.60 grammes of nitrogen.

"The Treatment of Diabetes Insipidus." Vienna Society of Medicine and Children's Diseases. La Semaine Medicale, 1904. p. 86.

At a meeting of this society, Hofbauer described the case of a patient who was passing 11 litres (16 pints) of urine daily, which was free from sugar. Strychnine, which is recommended by some authors, was without effect on this man. Schlesinger spoke of obtaining good results by reducing the quantity of drink allowed to a quarter of what had been used before. Schmidt had employed successfully in three cases podophyllyn; the drug was given with the intention of diminishing the renal hyperæmia by setting up hyperemia of the bowel. Nothnagel considered that in many cases thirst was the primary symptom, and if this could be diminished the polyuria disappeared. He therefore considered the best remedy was opium. In one case where the disease followed an injury to the head he had diagnosed pontine hæmorrhage; the case recovered after galvanic treatment.



WIDAL, CLAUDE, and others, on "The Retention of Chlorides and the Pathogenesis of Edema in Bright's Disease." La Semaine Medicale, 1903, p. 219.

At a meeting at the Société Médicale des Hospitaux, Widal gave the results of the study of a patient undertaken to determine the influence of chlorides on the production of œdema. He found that when chlorides accumulated in the body œedema resulted, and that this was attended by an increase of weight and albuminuria. On the other hand, when

chlorides were withheld the weight and albuminuria diminished and the cedema disappeared. A milk diet owes its advantages to the small quantity of chlorides contained in it, but when 10 grammes of chloride of sodium were added daily to this diet dropsy occurred; while, on the other hand, dropsy could be made to disappear upon a diet of raw meat, bread and potatoes, deprived of chloride of sodium. Claude believes. that the elimination of sodium chloride depends on the permeability of the kidney.

GRASSET. "Exaggeration of the Tendon Reflexes in AntiToxic Insufficiency. La Semaine Medicale, 1903, p. 217.

This note by Prof. Grasset states that he has for the last few years been in the habit of recognising states of blood intoxication such as occur for example in uræmia by the exaggeration of the tendon reflexes either in all four extremities or in the upper extremities alone. He says that this subject has been studied by one of his pupils, Dr. Germain, who has written a thesis upon it, basing his conclusions upon the observation of twelve cases, including not only kidney disease but pregnancy, chlorosis, gall-stones, cirrhosis of the liver, and typhoid fever. In his opinion this sign gives early warning of the on-coming of poisoning of the nervous system and indicates the need for active treatment such as bleeding.

N. KABANOV. "The Clinical Forms and Pathogenesis of Chronic Bright's Disease." La Semaine Medicale, 1903, p. 308.

The author has reported at length 121 cases of Bright's. Disease treated in the wards of Prof. Ostrooumov, of Moscow. He considers that the great majority depend upon toxæmia of internal or external origin, but he regards this cause as rarelyefficient in the absence of a congenital defect such as a constitutional tendency to gout or rheumatism, or of over-feeding. He is also of opinion that many of the nervous symptoms of uræmia depend upon hereditary peculiarities of the nervous system, and he attributes in like manner to hereditary

predisposition the cardiac accidents which may occur in the course of uræmia. Further, he attributes the cause of the oedema of Bright's disease to a diminution of the function of the sweat glands, which is either congenital or acquired. He believes gastro-intestinal troubles to be chiefly secondary and to occur in the terminal period of the disease, but the affections of the liver he refers to congenital defects of this organ. He insists upon the importance of anæmia as being one of the principal conditions of the disturbance of compensation. He devotes a whole chapter to the influence of heredity in developing the various clinical forms of Bright's disease, but at the same time he is sceptical with respect to these clinical forms, as he thinks that in practice it is very difficult to classify each case according to a definite type.

ACHARD. "A Comparison of the Elimination of Methylene Blue and Iodide of Potassium as Tests of the Anatomical State of the Kidneys." La Semaine Medicale, 1903, p. 241. Both these means have been used for testing the functions of the kidney, and according to Bard and Bonnet the differences in their elimination afford useful indications of its anatomical state. The comparison is very frequently made under defective conditions; they are not administered to the same person or they are given at different times, or finally the effect of methylene blue is determined by the duration of the elimination, while that of iodide of potassium is determined by the quantity excreted. In order to avoid these fallacies the author, in association with Grenet and Thomas, has injected at the same time, and in symmetrical regions, equal doses of methylene blue and iodide, and has determined for each the duration of elimination and the quantity passed. The results are to show great similarity in the elimination of the two substances. Further, they have not verified the rules formulated by Bard and Bonnet; in interstitial nephritis, when differences occur, they are not always the same, even when the same subject is examined at different periods; in tubal nephritis the elimination of both substances may be equally diminished, or there may be greater elimination of

« PreviousContinue »