PART III.

MEDICAL MISCELLANY.

Reports, Transactions, and Scientific Intellige~ce.

TRANSACTIONS OF T I t E 3/IEDICAL SOCIETY OF T H E

COLLEGE OF PI tYSICIANS.

SESSION 1881-82.

GEOI'~GE JOHNSTON~ ]V[.D.~ :President.

ALEXANDER I~IXON 1VIoN:rGO.~IERu M.K.Q.C.P., Honorary Secretary.

Wednesday, ~December 7, 1381.

J. W. MOORE~ I~.D., Vice-Presiden b in the Chair.

~ Alkapton " in Urine.

DR. GEORGE C. ARSISTRONG exhibited a specimen of the urine of a little girl apparently in perfect health, whose mother he had attended three years ago iu the worst puerperal convulsions he ever saw. The mother remarked that the child's urine, although perfectly normal in appearance when first passed, on being allowed to cool assumed a deep colour~ and stained the child's linen. He sent some of the urine to Pro- fessor Tichborne, who had made the following analysis : - -

" T h e specific gravity of this urine at 60 ~ Fahr. was 1"025. Albumen was absent. I t was acid to test paper~ and on standing gave a slight deposit, consisting of urate of ammonia and a little mucus. The urea was scanty, and not sufficient to account for the high gravi ty- - i t was 1"2 per cent., or 5"25 grains per fluid ounce. This urine presented a great peculiarity; it contained a substance which is only met with occasionally, and which has been termed alkapton. BSdcker met with a cas% and Lionel Beale mentions a case in which Dr. Johnson found it in the urine of an infant. This body stains the linen~ particularly when the urine becomes alkaline. I t behaves llke sugar, and reduces copper~ and probably it may be viewed in a somewtmt similar light patllologically. Estimated as a sugar it would give about 8 grains to the fluid ounce. The urine was examined for the bile reactions~ but gave none."

54 Transactions of the Medical Society

Dn. AR)ISTRO~'G said he put some of the urine into small bottles, and, having hermetically sealed them, left one exposed to l ight and air~ and put the other into a dark place. Tile latter specimen after six hours was not changed in any way.

The V~CE-PRESIOENT said that although this urine~ after a manner~ "behaved like sugar~" as Dr. Tichbornc's analysis statcd~ yet the reaction was very different. Under the influence of liquor potass~e without the aid of heat it struck a dark brown colour. Urine containing grape sugar~ according to his experience, did not change when liquor potass~ was added to it~ except under the influence of heat. Again~ with sulphate of copper the reaction of the urine was very incomplete--not at all so com- plete as that given by grape sugar. The results of the microscopical examination of the deposit of the urine were completely negative ; the deposit he experimented with consisted of a little mucus, epithelium, and a few small oil globulcs~ the presence of which may have been accidental.

DR. WALTER S)IITII said the Society were under an obligation to Dr. Armstrong for having brought before them this rare and interesting specimen of urine. Upon testing the samples with which Dr. Armstrong and Dr. J. W. Moore had kindly supplied him [-experiments demonstrated before the Society], Dr. Smith pointed out that the results confirmed the statements originally made by BSdeker in reference to so-called "a lkap ton" in urine. These a re - -1 . Strong alkalies darken the urine without the application of heat, and the coloration proceeds fi'om the surface of the liquid downwards--i.e, oxidation co-operates with the alkali. 2. Reduction~ at least partially, of the copper test. 3. ~on- fermentation with yeast. The term alkapton is, it is prcsumed~ derived from alkali~ dTrTw (fasten, or bind), from its relation to alkalies ; but the word conveys no real information~ and was given at a time (1861) when the physiological chemistry of the urine was very impel-fectly under- stood. From various considerations Dr. Smith thought it probable that the peculiar substance or substances in the urine exhibited belonged to the "aromatic series" of chemical compounds~ the physiological rela- tions of which group have been investigated with remarkable success during the past five years. Pending further investigation it would be premature to express a definite opinion on the subject in question.

DR. F~N~- asked had Dr. Smith yet submitted the urine to the test that he had mentioned in connexion with diabetic urine ? Was it dextro- gyrate or sinistro-gyrate under the polariscope ?

Dm S~ITII said he had not investigated that point~ but would do so if he got a further supply of the urine. I Ie had examined a specimen of the mother's urine~ and had found it quite normal. I t did not contaial the peculiar substances which was present in the child's urine.

of the College of Physicians. 55

Dm WALTER S~ITI~ read a paper on IdiopatMc Pericarditis. l i t will be found at page 1.]

The VIcE-PR~sXD~NT said the comparative rarity of idiopathic peri- carditis lent additional interest to Dr. Smith's communication. I t should be borne in mind that in one of the three cases there was apparently a hereditary tendency to pericarditis. The father of the patient had suffered from rheumatic inflammation of the pericardium.

D•. HEN~- KENn'ED~ said that ,in the course of thirty years he had seen some nine or ten cases of the kind, and he had a strong conviction that they generMly occurred in strumous subjects. In some of the cases a post mortem examination disclosed tubercles deposited in the lymph. IIe could not say that he had ever seen a case of pericarditis that~ in any sense of the term, could be called idlopathic~ unless perhaps one. I t was that of a woman between thirty and forty years of age who was admitted into the Whitworth Itospital for a very aggravated attack of dyspepsia. I Iaving occa~sion to get up on a winter's night~ she was seized with a rigor, and next morning she was,in a state of most fearful distress with her breathing. Her pulse was " t u m b l i n g " in a most extraordinary degree. Her illness went rapidly from bad to worse, and she died in the beginning of the third day. On a po.~t mortem exanlina- tion solid lymph in great masses was found poured out into the pericar- dium. The late Mr. Adams, in an admirable paper written at a time when the knowledge of cardiac physical signs was not nearly as perfect as now, gave a case of what might be called scrofulous pericarditis. The first case given by Dr. Smith appeared to occur in a strumous patient. The profuse acid sweating in another of the cases raised a suspicion of a rheumatic origin. I t did not follow that rheumatic peri- carditis might not exist without the joints being affected. IIe had twice seen perlcarditis precede the pain and swelling of the joints in a rheumatic attack. As a rule, when pericarditis occurred in a person of rheumatic diathesis~ and in the course of rheumatic fever, the pains subsided materially, and all the anxiety of the patient was referred to the heart.

])R. PATTON Said he had at present a patient who was suffering from an attack induced by a chill five or six weeks before. There was a congestive bronchitis of both lungs. The pulse was extremely weak, but there was no affection of any of the jolnts~ nor did the urine contain albumen. There wasfrottement over the heart. The patient's breathing became very bad, his pulse being very weak and quick~ and his respiration short, and he discovered that there was extensive pleuritic effusion on the left side. The fi'ottement then disappeared. The fluid was never completely absorbed or removed. Both lower lhnbs swelled. A few days after the acute attack came on there were a good many bursts of perspiration~ though the sweat had not the acid smell of rheumatic

56 Transactions of the Medical ,~ocietg.

perspiration. There were considerable deposits of ]ithates in the urine, which sometimes assumed a purple colour. The case was going on from bad to worse. The gentleman was sixty-five years of age. There had been no increased dulness over,the pericardium at any time.

DR. FINNY thought i t extremly probable that in Dr. Smith's second case the disease was of rheumatic origin, and affected pr imari ly the interior pericardial surface (myo-pericarditis). He concurred with Dr. Kennedy as to the possibility of rheumatic fever expending its whole violence on the pericardium alone. Last winter a girl came into the City of Dublin Hospital affected with choreie symptoms, but the chief evidence of disease was connected with the heart ; and in a short time pericarditis developed itself, and afterwards rheumatic affections of the joints, wrists, and elbows. He thought they should be careful, without some further explanation, in accepting the cases before them as examples of idiopathic pericarditis, because that term was exclusive of pre-existir~g disease. A person might have scrofulous disease, and the heart might be affected secondarily; and, adhering to this view, Dr. Smith's first case also should be excluded from the category of idiopathic, because there was a focus of tubercle in the apex of the r ight lung, and there was also a change in one of the ovaries~

DR. WALTER SMITII (in reply) said the word " s t rumous" was very elastic, and he neither affirmed nor denied the existence of strumous pericarditis. He would venture to lay stress chiefly upon three things in connexion with cases of pericardi t is--viz. , first, the general symptoms of the pat ient ; secondly, the fact that physical signs, as an exehlsive means of diagnosis, were sometimes insufficient; and, thirdly, that there were varying degrees of implication of the muscular tissue of the heart. In other werds, the clinical evidence pointed to a frequent co-existence of myocarditis with pericardit is; and the great danger of pericarditis lay in that direction and not in the serous inflammation itself.

The Society then adjourned.

SULPI l IDE OF CAltBON AND IODOFORS[ IN PIIAGED2ENIC ULCERATION~

Dn. J. CII~t~o~', at the Hospital of Salnt-Lazare, employs the following solution : - -Sulphide of carbon, 30 par ts ; iodoform, 5 parts. Iodoform dissolves reffdily in carbon sulphide, and the rival odours are mutually weakened b*y association. The pain is less severe than when the sulphide of carbon ahme is applied, and i t ceases as soon trs the liquid has evaporated. I t is best applied with a glass brush. Dr. Chdron has seen cicatrisatlon speedily result in cases which had proved rebellious to all the usual treatments.--Revue Mddicale. S. W.