Page images
PDF
EPUB

for such mischief, forces the debris and even corpuscles of the blood through the vessel walls, and produces the state of affairs just recited in the old theory.

Thus, briefly, we have the exciting cause of the disease according to each school.

I am not prepared to deny the claims of the old school in toto, for many reputable physicians have assured me that they have seen cases independent of the use of quinine, though so far I have been unable to find a single case of this kind when clinical notes had been taken. To the contrary, in a series of sixty consecutive cases in my own and the practice of other physicians who have taken bedside notes, not one presents a variation from the quinine history. However, I can readily imagine a case like this : having the pathological condition requisite, a chill or fever of the congestive type excited by malarial development alone, may so act upon the vessel walls as to precipitate the disease. But my experience in a goodly number of my own cases, and observation in many more in the practice of my neighbors, has been this: That malarial hematuria is a disease that perhaps adheres more closely to a type than any known in this section of the country; all variations depending either directly upon the treatment used, or being easily explicable by idiosyncrasies of the patient. This is the type : a patient suffering from the condition noted above has slight chills for several days; perhaps he does not notice. them at first, but he is finally cinchonized to prevent the next paroxysm. Instead of the usual chill comes a rigor of greater or less severity, generally anticipating the regular hour; but I have seen it retarded for a longer or shorter time. Following the rigor the temperature runs up to 1020, 103° or even to 105° in some cases. But it soon declines, and plays no part in the termination of the disease. With the rigor, or soon after, is discharged the characteristic“ black urine ;” nausea sets up; jaundice is marked, and we have the disease in its typical form. If let alone, it will pursue one of two courses : The urine will grow thick and scant, nausea increase, and jaundice deepen into a bronze. Finally, suppression of urine, with coma and concomitant symptoms of uremia, carry off the patient. The mode of death is determined by uremia ; it is generally by

[ocr errors][ocr errors]

heart failure. Or, the symptoms will grow more favorable, urine clearing, nausea growing less, skin assuming the color it bore before the attack, and the patient is left, but for extreme weakness, in the condition he was before the seizure, but generally minus the intermittents.

Variations from this type may be noted, such as multiplicity of rigors at the outset, or we may have no chills preceding the cinchonism, that state being produced as a prophylactic.

If malarial hematuria is ever intermittent independent of treatment, it is so rarely so that only the favored few see such curious cases, and they play no part in general practice.

Let us now note the treatment of this disease. The advocates of the old theory use quinine as their base, from the mistaken idea that they will have another paroxysm if some antiperiodic is not given. It is impossible to justify their treatment in any other way; for of course they know the tendency of quinine to suppress urine, to depress the vasomotor centers, and especially to produce hematuria — homeopathy. Those of the new theory as their base of treatment eliminate quinine and heal the kidney lesions to prevent uremia, knowing that all secondary paroxysms are new attacks produced by quinine. If they were to use quinine knowing that the vast majority of these cases are produced by quinine, then would they be “in folly further gone ”-idemopathy.

But old or new school, we have but one pathology to heal, and quinine is contraindicated. Malaria produced the condition, and in some cases possibly the disease, but is now passive, and what we are to dread is uremia.

Dr. R. S. Williams of Mt. Meigs, Ala., has given us the simplest mode of avoiding uremic poison in his turpentine and Epsom salts treatment; a treatment that so rarely fails, that a death from malarial hematuria treated thereby is a curiosity. As the disease is typical, so is the treatment routine. A tablespoonful of Epsom salts dissolved in water, and eight drops of turpentine (in a capsule is best), to be given every three hours. After the salts has acted four or five times, it can be given at longer intervals; but the turpentine must be continued until the urine clears up, then at longer intervals as seems best. Repeat every vomited dose.

[ocr errors]

Dr. Williams uses Fowler's solution from the first. But if it is contraindicated by the condition of the stomach, I wait until after the attack and administer it with iron; because, I do not consider it as treatment of the disease so much as of the condition. Nourishment is of great importance. Emergencies, of course, must be met. Nausea, if distressing, can be controlled by any favorite prescription; if only moderate, let it alone. Opium is contraindicated; use other hypnotics. if called for. The rationale of this treatment is, that turpentine is a healing diuretic, repairing the kidney lesions, and stimulating the functional tubules to action. It also stimulates the nerve centers. The salts sluices out the bowels, removing all offending matter, and leaving them in a soluble condition.

The arsenic is simply the antimalarial tonic, used to correct the condition. For after an attack of hematuria, the condition remains that made the disease possible, and the wise physician will use every. means to tone up the system to its normal pitch. If lack of space did not forbid, I could give quite a list of cases very instructive and interesting, but will defer until another time.

HAY FEVER AND ITS TREATMENT.

Read before Tri-State Medical Society of Miss., Ark. and Tenn., Nov. 19, 1891.

BY J. I. TAYLOR, M.D., MEMPHIS.

cases.

In 1889 I reported the treatment of several cases of hay fever through the pages of the Memphis Medical Monthly. Since that time I have treated some half dozen additional

In fact, have seen a number of cases, and find the affection so prevalent, that I think a paper on the subject will prove of sufficient interest to claim your attention for a few moments.

I will not go into the pathology, but propose, after touching casually upon the etiology, to give a mere clinical report of cases treated. Since 1819 various persons have advanced different theories as to its cause, its periodicity, and its cure. Passing these by, I note that Elliotson pointed out the fact that pollen was the exciting cause. This opinion was con

To prove

curred in by various authorities, until in 1883 Sarjous of Philadelphia, whose opinion I indorse, said that three conditions were essential factors in its production : First, an irritant (external); second, a predisposition on the part of the system to become influenced by the irritant; and, third, a vulnerable or sensitive area through which the irritant acts with effect upon the system. The same substance, however, does not act upon all persons alike; for instance, the pollen of the rag weed, said to be the most potent or prolific source, does not affect some hay fever patients ; in them we find the pollen of some other plant to be the exciting cause. the effect of such substances, when we remove the patient from it, or close the nose with some contrivance to exclude its entrance, we find the symptoms subside and the patient freed from the affection. Again, at any season of the year, by placing in the nose this substance, all the distressing symptoms of hay fever are produced. Quoting again from Sarjous : “Another evidence that pollen is a factor in the affection, is the regularity with which the majority of plants undergo the different phases of their growth, each recurring on the same day every year, and, in some instances, the same hour. This not only explains the periodicity of neuroses, but the precision with which most sufferers can prophesy the onset of their attacks.” But the mere irritating property of the substance is not the only factor in its production, as stated above. We find in the subject a neurasthenia, an abnormally sensitive nerve center, through which the pollen acts with effect. We know that a large area of the nasal cavity is supplied by branches of the spheno-palatine ganglion ; not only here but they extend to the hard and soft palate, the pharynx, and larynx. I have found in all cases falling under my care, not only this neurasthenia but various hypertrophies situated at various points in the nose.

We have then, as stated above, an irritant acting through a sensitive area. Conceding these points, we pass on to the treatment.

We know how futile local and constitutional medication has proved in the past. The only reliable remedy heretofore has been the removal of the patient beyond the reach of the irri

tant, generally to some mountainous point or upon the ocean ; but as this is beyond the means of most persons, we have tried, and I think have found, the means of giving them relief at home. This treatment is the removal of the sensitive nerves. Whether original with Sarjous I don't know, but through him I first began to practice it. We illuminate the nasal cavity, and with a probe hunt out the sensitive points; when one is found, it is indicated by a burning, itching sensation, with lachrymation, and, in fact, most of the symptoms of hay fever. We mark this point, and proceed to find the others; when I have found and located them all, I carry in the electrode and at a white heat sear through each nerve filament, thus eliminating the points which are acted upon by the offending substance.

I will say here that I usually cocainize the Schneiderian membrane to avoid giving pain, but without it, the cautery (at white heat) causes very little suffering—much less than when an acid is used.

The after treatment is a detergent wash, to be used twice or thrice daily until the sloughs are removed, then ointment composed of cocaine gr. vj., and white vaseline zij. Mix and use in nose when painful.

In the patients operated on by me the relief has been immediate, but as to its permanency beyond the second season I cannot vouch, as this is the length of time since I first began the treatment. Having been absent from home until late this fall, I have had no reports from my patients up to this time. I told each one to notify me immediately if they should experience a return of the trouble. Having heard nothing from them, I argue favorably for its permanency.

* Among the patients reported treated in Dr. Sim's journal I will mention only one. The others are but a repetition of the same.

In September, 1889, Mr. S. of North Mississippi, banker and merchant, consulted me for treatment of hay fever. I found him in the midst of an attack. His trouble began each year in the latter part of August, and continued until the first frost in October. Had usually gone to the mountains, but that year business prevented and he was forced to seek

« PreviousContinue »