A CONSULTATION OF MM. RAYER, ORFILA, and CAFFE, ON A CASE OF MILKY URINE: CHEMICAL EXAMINATION OF THE URINE AND BLOOD: PRACTICAL REMARKS.

M. Costa, 22 years of age, a native of Brazil, stated that, four years ago, he first observed that his urine had occasionally a milky appearance: his general health at the time was very good, and he experienced no uneasiness in any part of the urinary apparatus. A year afterwards he began to suffer attacks of severe pain in the region of the kidneys and in that of the bladder the pain was frequently excessive before and during the evacuation of his water, causing him to bend himself forwards and draw up his limbs to his stomach. The urine at this time was extremely thick, so that it flowed out with difficulty, and had often a quantity of blood mixed with it.

These attacks usually lasted for about twelve or fourteen days, and were treated with copious leeching of the hypogastrium and perineum, warm baths, and the use of nitred drinks. The cessation of the urinary distress was slow and gradual, and was not complete for upwards of three months; the state of the urine varied every now and then; being at one time milky, at another time natural, and at a third more or less bloody.

From this period, the urine often remained quite clear and normal for two or three months at a time, and then re-assumed a milky appearance without any appreciable cause. The exercise of riding seemed generally to favour the reestablishment of a healthy state of the secretion.

While at Rio Janeiro he had taken a quantity of terebinthinate preparations, and was kept on a light unstimulating course of diet.

In July 1836, he came to Paris with the view of consulting some of the leading physicians there for his malady; which, although it had not visibly affected his health, was nearly stationary and made him very uneasy as to the consequences. His urine had been quite natural during the whole of the voyage to France.

On reaching Paris, he consulted M. Caffe, who recommended at first a decoction of willow-twigs to be alternated with the waters of Vichy, Barege-baths, warm clothing to the surface, and avoidance of exposure to cold; and subsequently a decoction of horse-radish, and pills of sulphate of iron and sub-carbonate of potash. These means seemed to have no effect on the complaint.

Towards the end of September, M. Costa visited Belgium and England, continuing the use of the chalybeates during the whole of the time. The travelling certainly benefited him; but the urine again assumed a milky aspect shortly before he returned to Paris.

MM. Orfila and Rayer now joined M. Caffe in consultation upon this curious case; and the following memoranda of the symptoms were marked down.

The urine was very seldom more abundant than the quantity of liquid drank. The milky colour varied exceedingly at different times, both in intensity and durability at one time the urine was nearly as white as milk; then it was only somewhat troubled, and at length it assumed a perfectly healthy and limpid aspect. These changes rapidly succeeded each other without any appreciable cause. Even when milky, the urine had always its characteristic smell and taste. Since the use of the chalybeate medicines, it had been much less frequently bloody than it was before; and no pain in voiding it had been experienced of late. The general health of the patient seemed to be perfectly good; his appetite was regular and vigorous, and his sleep was always sound. The urine was generally clear for some time after sexual intercourse.

M. Guibourt, professor of pharmaceutical chemistry at the Ecole de Medicine, was requested to analyse the urine at different times; and the following is the substance of his report to the three physicians in attendance.

"The urine of M. Costa is sometimes white like milk; at other times it is of a blood-red colour; and at other times again it is quite clear and of a healthy appearance.

When it is red, if left to repose, a dark red deposit is found to subside to the bottom of the vessel, the supernatant liquid being then always more or less decidedly white and turbid.

The milky urine contains sometimes so much fatty matter, that the surface becomes, after a short repose, covered with a thick layer, like cream. If sulphuric æther be added to the milky urine, it quickly becomes nearly quite clear, and the æther acquires a yellow colour. By evaporating this æther, a quantity of fatty matter may be readily obtained.

The milky urine, which has been made transparent by the addition of sulphuric æther, forms an abundant coagulum of albumen, on being boiled. Nitric acid also coagulates it; but acetic acid does not. This proves that there is no caseine in the urine; and hence that, strictly speaking, it should not be called milky.

The milky urine, after it was freed from all the fatty matter by means of æther, and also from its albumen by boiling, was found, on the addition of nitric acid, to deposit beautiful crystals of nitrate of urea. We therefore conclude that the urine of M. Costa differs from healthy natural urine, only in containing a quantity of fatty matter and of albumen, to which may also be added the occasional admixture of the colouring matter of the blood, superadded to the usual ingredients of the secretion."

The results of M. Guibourt's analyses, if compared with those by Dr. Prost of what he calls chylous urine, shew very clearly that the present case is to be considered as one of this kind. That the term chylous is more appropriate than that of milky, appears from the circumstances that no caseine can be detected in the secretion, and that, if we add a small portion of genuine chyle to healthy urine, we obtain a fluid which will be found to contain albumen, fatty matter, and sometimes also a certain proportion of the colouring matter of the blood along with the usual ingredients of urine.

The attention of MM. Rayer, Orfila, and Caffe was now directed to ascertain the state of the blood in their patient.

Four ounces were drawn from the arm, and M. Guibourt was again requested to lend his assistance.

The blood, after some hours' repose, was found to be a gelatinous trembling mass, without any appearance of white buff (couenne blanche) on the surface. After twenty-four hours, when shaken about in a glass vessel, it became completely fluid-a circumstance which seemed to indicate an utter absence of fibrine. This liquid blood was mixed with two parts of alcohol, for the purpose of coagulating it: the coagulum was then pressed and dried. It weighed seven and a half drachms, or nearly one-fourth of the weight of the blood. It was pulverulent, and of a pale reddish-white colour; whereas the coagulum of healthy blood, after being treated in the same manner, is a hard vitreous-looking substance of a very deep red-brown colour.

It appears therefore that the blood of M. Costa contains much less colouring matter than healthy blood does. It is to be remarked however, that this difference might be partly owing to the large quantity of albumen present in the former; for certainly the quantity of dried coagulum-seven and a half drachms from four ounces of blood-exceeds that usually met with in the analysis of healthy blood; and as this coagulum was found to contain very little fibrine, we must suppose that the solid matter was chiefly albumen.

By subsequent experiments made with æther on the dried coagulum of M. Costa's blood, and on the same quantity of dried coagulum of healthy blood, it was found that about four grains of a fatty, solid, opaque substance was ob

This deposit, although it much resembled a coagulum of blood, is not strictly so. It consists of the colouring matter only, without any of the fibrine. This is readily proved by adding some æther, which completely dissolves it and leaves no trace of the deposit.

tained from the former, and only two grains of a coloured residue, partly fatty and partly saline, from the latter.

From all these researches we may fairly conclude that the blood of M. Costa differed from healthy blood in containing less fibrine, and a greater quantity of albuminous and fatty matter; and therefore that it more nearly approached to the composition of chyle than the latter.

The practical application of these conclusions is, that the alteration of the urinary secretion may be considered as dependent upon an abnormal state of the circulating fluid-a state which seems to depend upon an imperfect transformation or assimilation of the chyle with the blood. The case of M. Costa was therefore considered by M. Rayer and his colleagues as one of primary vitiated sanguification or hematosis. The treatment which these gentlemen recommended was as follows:

1. The patient to take fasting every morning, during several months, six steel pills.

2. To take an ounce of cinchona wine every day, an hour before dinner.

3. To use a cool bath, to which two ounces of sulphate of potash have been added, for half an hour at a time, thrice a week.

4. Every evening before going to bed, to take twenty-four grains of subcarbonate of iron in a wafer or in stewed fruit, (dans du pain à chanter ou dans de la compote.)

5. The food to consist, in a great part, of beef or mutton, either roasted or grilled.

6. The ordinary beverage to be of some generous wine coupé with a chalybeate water.

7. Sea-bathing during the fine weather.

8. The occasional attacks of strangury being attributable altogether to a mechanical obstruction of the urinary passages from coagula, recourse must be had to diluents, and, if necessary, to the use of the catheter to relieve this symptom.

Before concluding these remarks on this rare affection, we may briefly state 1. That in the cases of chylous urine mentioned by Dr. Prout, the patients, although some of them had been subject to the irregularity for several years, didnot exhibit any marked disturbance of the general health.

2. That the cases of hæmaturia, which are of frequent occurrence in certain tropical climates as in the Isle of France, and are not unfrequently followed by a milky or chylous state of the urine, are not usually regarded as attended with much danger.

From the report of a discussion, which recently took place in the Academy of Rio Janeiro, the metropolis of Brazil, it appears that this abnormal state of the urinary secretion is not of unfrequent occurrence there, especially among females; and that the gravity or danger of the affection is by no means commensurate with its tediousness and resistance to therapeutic measures.

3. Cases of milky or chylous urine are rare in Europe. In those, of which we have any report, the general health of the patients does not seem to have been much disordered. In some, however, the affection seems to have been followed by diabetes.

* The formula for these was

Take of Subcarbonate of iron.... 3j.

P. cinchonæ rubræ

P. canellæ ...

Эј.
gr. xij.

M. ft. misce in pil. xxiv. div.

It seems that the late Ex-Emperor of Brazil, Don Pedro, had consulted M. Rayer, in consequence of a milky state of his urine. It is not stated whether the health of the royal invalid suffered from the disorder.

The preceding details are extracted from a report which is signed with the names of MM. Caffe, Orfila, and Rayer.-Le Presse Medicale.

UTILITY OF IRON (ESPECIALLY THE IODURET) IN SOME SYPHILITIC
AFFECTIONS.

M. Ricord of the Hôpital des Veneriens at Paris has, for some time past, used pretty extensively the proto-ioduret of iron in cases of secondary syphilis, when the system of the patient is feeble, and especially if at the same time it is scrofulous. He reports very favourably of its beneficial effect under such circumstances.

In numerous instances where the ordinary methods of treatment had been ineffectually tried, the constitution seemed to rally quickly under the use of this preparation of steel, and the local disease at the same time began to assume a healthy action. Repeatedly have we seen, says M. Ricord, old extensive ulcers of the throat, which had long resisted all the usual topical applications and internal medicines, rapidly change their aspect under the influence of the protoioduret, and, within a very short time, heal and cicatrize. In many patients affected with caries of the bones of the face, cranium, and extremities, the process of separation of the diseased from the healthy parts has been surprisingly quickened, and the general health has at the same time been materially improved by its use.

Another set of symptoms, which has been much benefited by the use of the proto-ioduret, deserves to be especially noticed-we allude to old tedious discharges from the vagina and urethra, occurring in persons of enfeebled lymphatic constitutions. The dose, which M. Ricord recommends, is six grains during twenty-four hours at first: this is to be gradually increased to half a drachm or two scruples. Besides the internal administration of the ioduret, its external use, as an injection, has been extensively adopted by M. Ricord in cases of obstinate gleet. The strength of the solution is usually half a drachm to eight ouuces of water in a few cases the quantity of the ioduret has been raised to two drachms.

As illustrative of the beneficial influence of steel upon certain forms of venereal ulceration, we may here appropriately mention that M. Cullerier has frequently used the carbonate of iron with happy results in cases of unhealthy ulcerated buboes.

The following case furnishes an appropriate example.

A middle-aged man was admitted into the Hôpital du Midi with numerous chancres on the penis, and a very large bubo in the right groin. A blister was applied over this swelling, and next day the denuded surface was covered with lint wetted in a strong solution of sulphate of copper (3j. to 3j. of water :) an eschar was formed, and when this separated, a quantity of pus was discharged. The swelling however remained almost as large as ever; and friction with mercurial ointment was therefore resorted to. The gums becoming painful, the ointment of the hydriodate of potash was substituted. Subsequently the kali causticum was applied, to cause another opening in the tumor. The ulcerated bubo began to assume a most unpromising aspect; its edges being everted, and its base black and oozing blood. Leeches were applied several times on its inner surface, but without producing any benefit. (Is not this rather a strange practice). -Rev.

The patient, after three months' suffering, was greatly reduced in flesh and strength; the ulcers were fungoid and livid; the gums were spongy and bled on the slightest pressure; and the general health seemed to indicate a scorbutic cachexia. M. Cullerier now recommended the internal use of the carbonate of iron, and, by continuing it for a month, the man was discharged quite well.— La Lançette Française.

MISCELLANIES.

A NEW WEEKLY CONTEMPORARY.

START not gentle editors of the antipodes of Medical Journalism-ye of the Gazette and Lancet. We do not propose to turn hebdomadal, nor do we announce a rival. Your interests are safe at present. Still you will be spared the verification of the adage, that, "though two are company, three are none." Dr. Ryan is not resuscitated, nor has Henderson of the Old Bailey, obtained a respite for some tenant of the condemned cell on condition that he should work for life in irons. Some modest gentleman has not yet discovered that all your matter is mere moonshine, and your correspondents so many huffers-that practical knowledge is most found where there is least practice-that acquaintance with physic is not to be sought among the regular "saw-bones," but in those fortunate physicians, who, having been bred to something else, turn doctors when the other trade has failed-that an enormous capital is requisite for criticism, and proves it by displaying a stock of impertinence that would suffice for all the daily papers-in short, that a new journal is absolutely requisite, and that he is the man who has just the proper quantum and no less, of judgment and wit, of learning and fun, of strict impartiality and undeviating infallibility. No Katerfelto of this description has yet sent the bellman round, and our weekly contemporaries of London may still continue to exist.

The new Journal is a Paddy. He comes direct from Dublin, and "His legs that would make a chairman stare," display an Irish breadth and length, refreshing to see after the shankless Cockneys.

The "Dublin Medical Press," is our hero's name, given, we have no doubt, on the Hibernian principle, by which Bill was called Robinson-" for shortness.' Suppose, readers, we tell Patrick to bow and address your honours. He is well up in the blarney :

"It is impossible, by mere assertions, to prove the sincerity of professions, or to remove the suspicion that men act from interested motives only-but let the readers put themselves in the place of the editors, and then see whether their position is so enviable, or the prospect before them so flattering as might at first sight be supposed. Great labour, pecuniary risk, and personal obloquy are sure to be encountered; the return for which, it must be admitted, is not necessarily the most gratifying. In seeking the support of the profession, therefore, they are almost induced rather to claim it as a right than to supplicate it as a favour. Every man who can think must admit that something of this kind is required, and that the want of it has been a positive injury to every individual. In the country, gentlemen have been kept in total ignorance of what is going on in the metropolis, or are misled by imperfect information or misrepresentation. In Dublin, they are equally ignorant of the real state of the profession in the provinces. Year after year information of the utmost value has been lost, from the want of an efficient vehicle for its effectual diffusion, to which all, without repugnance or hesitation, could have recourse. Emulation has ceased, and a deplorable apathy has been engendered by the absence of competition and the want of the stimulus of example. The rights of individuals and the interests of the profession at large have been compromised or sacrificed from the want of a medium through which their complaints could be conveyed, or their wants made known, in an authenticated form, to the legislature or the public. The managers No. LX. TT