MEETINGS OF SOCIETIES.

GLASGOW MEDICO-CHIRURGICAL SOCIETY.

Session 1880-81.

Meeting Y.?14th January, 1881.

Dr. George Buchanan, President, in the Chair.

Dr. Allan read a paper on a case of enteric fever, in WHICH QUININE WAS EMPLOYED AS AN ANTIPYRETIC (page 363).

Dr. Hugh Thomson was surprised to find that quinine had so little effect in reducing temperature. So large a dose as 30 grains, in a case of typhoid fever, where the digestive organs were so much deranged, would, he thought, be too irritating to take into the stomach, judging by what he had experienced in giving much smaller doses in cases even where the gastric lining was not so irritable. He had seen a dose of 20 grains cause extreme sickness and depression and vomiting, so that he should have expected the 30 grains to produce even more depressing effects than it had done. With regard to the treat* ment of typhoid, he thought it was rather the treatment of

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symptoms as they arose, the principal part consisting in

nourishing the patients and tiding them over the disease. Dr. Perry thought Dr. Allan had come to the right con-

clusion, though perhaps it was rather rash to go upon one case alone. It was, however, in keeping with the conclusions arrived at last winter, after a paper by Dr. Gairdner, in which he reviewed the treatment on the Continent by large doses of quinine and other antipyretics. Small doses may do good by acting as a stimulant and doing away with the necessity for large doses of stimulant, but large doses seemed to him to be rather depressing.

Dr. {jrairdnev agreed with Dr. Allan in his conclusions, but thought there was a difficulty in speaking from single cases on the action of a remedy, particularly if the action as in the

present case was temporary, and where repetition was neces- sary to bring about any result at all. He had no doubt of the

power of quinine and other antipyretics, such as ice, cold

water, salicine, digitalis, &c., to bring down the temperature as a physical fact, but he had great doubt of their beneficial

action, though in some special cases the}7" might avert dangers, perhaps not without bringing on other dangers. The tendency he thought was to over-rate the value of antipyretics. A case had occurred in his wards quite recently with a certain degree of parallelism to that of Dr. Allan's, and as his observations had been quite independent, it might be interesting to state the circumstances. It was a case of perfectly uncomplicated typhoid fever, for the man had hardly any diarrhoea, very little delirium, and no pain to speak of; his condition was in fact a singularly apathetic immobile one, and but for the

thermometer, the infallible test of fever, one would hardly have known that he was suffering from anything. He seemed to have been three weeks ill when first seen on 18th December, when his temperature was 104? F., and there were rose spots in enormous abundance. The temperatures oscillated a good deal, but did not rise above 104? F., and as there was nothing calling for active interference, he received the normal treat- ment of typhoid, milk diet, plenty of milk, and watery drinks, and general care. On 28th December the temperature touched 104? F., and near midnight he got 30 grains of quinine in divided doses, and this was followed by a fall of 7? within twelve hours, to 97'2? F.; the pulse going down from 80 to 64. Next day the temperature had risen to 103'8? F., and quinine was again given with a fall of 6?, but it rose within twenty-four hours again to 103*8? F. No quinine was given this time, and there was a fall of 3? or 4? spontaneously. Next

Medico-Chirurgical Society. 395

night it rose to 104*2?, and again quinine was given, followed by a fall of 8? to 96*4?. He was left alone after this without

any quinine. The temperature continued to oscillate, but did not again rise to hyper-pyrexia. It will be seen that though the effect of individual doses of quinine is exceedingly marked, its influence on the progress of the disease is very small. There was abundant time to see this, for the patient is now in the sixth week of the fever, and still the temperatures are not normal. There has been a gradual fall of the temperature since the fourth week, and quinine did nob shorten the fever at all. If the action of quinine be so temporary and so purely on the temperature, are there not other disadvantages to be taken into account ? Can any one knowing the importance of nourishment in typhoid fever say that the administration of quinine in 30 gr. doses every three hours is conducive to the

proper treating of the fever ? He thought that the adminis- tration of a poisonous drug like quinine, unless to overcome a symptom of paramount importance, was bad treatment, and that the results in Glasgow, with far less active treatment, were just as good as those by antipyretics. Liebermeister, in his later papers, says that he does not give quinine as a routine practice, but no rules or guides are set down as to when

to give it, and how often. It would be interesting to have a trial made in the fever hospital of the cold bath treat-

ment in some suitable cases, so that a comparison could be made.

Dr. Allan reminded Dr. Gairdner that they had to consider two aspects of the question, and not only the medical, for if the public knew their friends were to be plunged in cold baths which, to them, would seem an unjustifiably heroic treatment, the difficulty, which was already great, of inducing them to come to hospital would be increased.

Dr. Coats showed some specimens illustrating con-

genital malformations of the aortic VALVE. His obser- vations will be found at page 372.

Dr. Gairdner mentioned, with regard to the last specimen shown by Dr. Coats, in which there was a complete diaphragm in place of the aortic valve, and also disease of the tricuspid, that the history of the case was certainly that of rheumatic endocarditis about five years before death; but whether that was super-imposed on a congenital condition of the

valve or not he could not say. Dr. Peacock, in his book, x

places congenital malformation of the valves as one of the

predisposing causes of disease of the valves, and ranks it as almost one of the chief. To show how long these little lesions

396 Meetings of Societies.

may lie latent, he mentioned the case of one of his oldest

acquaintances. He told him that he had become aware of

something wrong with his aortic valve so long ago as when he was attending the clinique of Laennec; that he had got a flexible stethoscope and had auscultated himself, and had had a great deal of worry about it. It passed from his mind, however, in time, and he went on with a large practice, dying at the age of 70 of tubercular peritonitis. At the post-mortem examination the aortic valves were found malformed, and the heart not hypertrophied, but atrophied, in accordance with the tubercular condition.

Dr. M'Vail brought before the meeting a patient suffering from the convulsive tremor described by Dr. Hammond.

The patient, a lad twenty-three years of age, is subject to chronic convulsive attacks affecting the muscles that proceed from the spine to be inserted into the occiput, together with a few of the upper fibres of the trapezius. No other muscles than these are affected.

Each attack lasts for about ten minutes, and during its

continuance, if the observing hand be placed on the affected muscles, the contractions are felt to be at about the rate of

ninety in the minute, occasionally faster and occasionally slower. When the patient first presented himself at the Western Infirmary Dispensary he had two or three seizures every day, and invariably one when he laid his head on the pillow on going to bed. An attack could at any time be brought on by pressing the hand firmly on the top of the head. The ailment first made its appearance more than two years

ago, when he was reading a placard on the street. It recurred a month afterwards, and after this every day or two, and soon every day. About a year ago he had occasional very slight and brief trembling movements of both arms, but never so severe as to cause him to drop anything he might have in his hand at the time. He had been very considerably under medical treatment

without any good result. As the symptoms seemed to point to the motor convolutions about the fissure of Rolando as the probable seat of the morbid action, blisters were applied to the scalp in that neighbourhood, and considerable improve- ment has followed. On several days he has had no attacks save the one on putting his head on the pillow at night; it is intended to repeat this counter-irritation at short intervals for some time to come.

Medico- Ghirurgical Society. 397 -

Meeting YI.?4th February, 1881.

Dr. George Buchanan, President, in the Chair.

Dr. Robert Kirk, Partick, read a paper on researches on ALBUMEN, WITH SPECIAL REFERENCE TO ALBUMINURIA, which

appears at page 337. The President expressed his appreciation of the merits of

the paper, especially in the application of chemical knowledge to pathological facts.

Dr. Neivman said he also had worked at the subject of albumen, and agreed generally with Dr. Kirk. He had paid attention to albumen in fluids?as from ascites, ovarian cysts, &c. The presence of salts is an important factor in the behaviour of albumen. When dialyzed, these fluids gave

similar reactions in all cases, and so the differences in these fluids described in books disappear on dialysis. Dialysis must be carefully executed?a shallow dialyser and distilled water for three or four days being necessary. When thus effected, salts almost disappear, as shown by nitrate of silver giving very little precipitate of chlorides. The test described by Dr. Kirk, of the addition of soda and then nitric acid is very

important and very delicate; but picric acid is equally so.

Dr. Newman has tried chromic acid, and it is also equally delicate. He adds salt to the chromic acid solution. In

testing he adds the urine to the chromic acid solution; and in using nitric acid, also, he puts the acid into the test tube first. As to physiology he agreed that albumen passes through the

Malpighian tufts of the kidney in health. Some years ago, Dr. N. read a paper showing that albumen passes through membrane, especially in the presence of cystalloids. In health, a certain amount of albumen passes, and is absorbed along with other constituents. Observations in a case by Dr.

Finlayson seemed to indicate that albumen is absorbed even by the bladder. In this patient albumen was present in the urine at night, but not in the morning. He made

patient half empty his bladder at night, so as to leave some albuminous urine in it, but next morning he found no albumen, showing that the bladder had absorbed albumen. If

the bladder does so, then the uriniferous tubules probably do. Dr. M'Vail thought this paper threw light on hrematinuria.

It is important if it be established that in renalbumen we have a body different from any albumen in the blood. In

hsematinuria we have, in the urine, a very peculiar albuminous body, apparently owing to some peculiar nerve influence acting on the renal cells. There was a case, for instance, in which

i1

398 Meetings of Societies.

washing in cold water brought on hsematinuria. The pancreas normally secretes albumen, and it would not be astonishing to find the kidney, under peculiar circumstances, secreting this peculiar substance. And so in Bright's disease we may have the kidney secreting this peculiar albumen.

Dr. Kirk agreed with Dr. Newman that the differences described in albumens depend largely on differences of pro- portions of salt and acid. But the distinctions between

ovalbumen, serumalbumen, and renalbumen are sufficient to make out different varieties. It is possible that when large amounts of albumen are present, the kidney epithelium may not be able to alter the whole albumen into renalbumen, and so we may have some serumalbumen in the urine. Dr. K. has not worked with urines with large quantities of albumen.