The American Journal of the Medical Sciences, 1893, Vol. 105 (Classic Reprint)
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Excerpt from The American Journal of the Medical Sciences, 1893, Vol. 105 Case I. - A well-known professional man consulted me about four years ago, suffering from indigestion, marked flatulence, and constipation. He was very nervous, much alarmed about himself, and greatly annoyed by an irritability of the bladder. Albumin was found in small quantities in the urine, as were tube-casts of hyaline character. The albumin was most marked in the afternoon urine. Repeated examinations showed much the same thing, except that on one occasion hyaline and a few epithelial casts were seen without albumin being detected. The acid urine, the specific gravity of which was never below 1022, and frequently upward, often deposited quantities of brickdust. Extremely heavy sediments were noticed after drinking a glass of beer in the evening. The patient was very nervous about himself and despondent, and all work became irksome. A European trip and a carefully regulated diet,largely lessening the nitrogenized substances, did him great good. For two years there has been no trace of albumin in the urine. Previous to its disappearance, it was only detected by the turbidity with acetic acid and boiling, and was not found by nitric acid. In an examination made fourteen months ago by a professional chemist who had previously repeatedly found albumin, the urine is spoken of as intensely acid, as containing excessive amounts of uric acid, but without a trace of albumin or of sugar. The patient consulted me recently again, being much annoyed by irritability of the heart and pulsation of the abdominal aorta. I found no organic disease of either. The second sound of the heart was sharply defined, the temporal arteries were full and prominent, suggesting atheroma; indeed, I had so noticed them before, but the pulse did not indicate this, being small and of doubtfully increased tension. His nervous system was again disordered; he had many of the nervous symptoms of litbæmia. He dreaded going into crowds and coming into contact with people, and was much disturbed about his own condition. The urine was intensely acid, depositing urates, but it did not contain a trace of albumin, not even when boiled with acetic acid. The irritability of the bladder had passed away. Strict diet, chiefly of vegetables and milk, is again doing good. He is keeping the urine free by the use of Poland water or of Londonderry Lithia, and is taking systematic exercise in the open air. The circulation is being controlled by aconite, and his improvement is very marked. In the case to follow, the symptoms were so much like those of ordinary Bright´s disease, from which the patient supposed himself to be suffering, and the albuminuria was at first so decided and so persistent that it was only by a close study of the symptoms for some time that their true meaning was discerned. Case II. - J. H. M., about forty-five years of age, suffered at one time from irritability of the bladder, due to a stricture which Dr. Keen cured by dilating. When first seen by Dr. Keen, who subsequently referred the case to me, the urine was found to be normal. Mr. M. was a very nervous man, greatly troubled with flatulent dyspepsia; indeed, his chief annoyance was the constant belching and the intestinal rumbling. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com
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