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TWO CASES OF LEAD-POISONING, WITH VERY LARGE QUANTITIES OF ALBUMEN IN THE URINE.
BY E. J. SHEARMAN, M.D., M. R.C.P., F.R.S.E., ETC.
Physician to the Rotherham Hospital.
THE two following cases of lead-poisoning, accompanied by the excretion of very large quantities of albumen in the urine, are so interesting and unusual that I am induced to publish them, in the hope that some gentleman who has studied albuminuria more carefully than I have, may be able to account pathologically for the combination.
On the 29th November, 1873, I was called to a gentleman, aged 60, who had been seriously ill for the last twelve months, and had never been well for more than five years. I found him delirious, sleepless, with dry skin, pulse 130 to 140, very feeble respiration (30), no abnormal chest sounds, no appetite, most obstinate constipated and painful bowels, requiring very large doses of the most powerful aperients, and passing a large quantity of urine of sp. gr. 1008, half of which became solid on boiling and adding nitric acid; and blood-discs were abundantly seen under the microscope, but no casts. He was totally unable, from want of muscular power, either to walk, turn round in bed, dress or feed himself. This had been his condition for several months. He persisted in the idea that he was labouring under suppressed gout.
My first impression was that I had to combat a confirmed case of albuminuria, and for a day or two I prescribed accordingly. But I was then consulted by a lady, aged 37, who lives in the same house, and found she had been suffering,
for five or six years or more, from various remarkable spasmodic attacks, and was reduced, by their constant occurrence, from a well-made, handsome woman, to a mere skeleton. She had been scarcely able to walk for twelve months; could never relieve her bowels except by taking enormously strong medicine; was frequently seized with violent tonic spasms in the arms, fingers, legs, abdomen, and chest, as if she had been taking strychnine; and at one time, the friction of the muscles of the chest was so loud, that, combined with other symptoms, I had great difficulty in satisfying myself she had not pleurisy; her pulse was usually very quick and weak; tongue and skin dry; and no appetite. But, strange to say, this patient also had a large quantity of albumen in her urine, the sp. gr. being only 1010.
These symptoms had existed several years, in both patients, and no remedy which had ever been prescribed, except change of scene and air, relieved them: and both informed me that their appetite and health always improved in a short time after leaving home.
On reflection it occurred to my mind that these symptoms might be owing to the poison of lead; and on examining the gums of each, broad blue lines were discovered. I then ascertained that they had been drinking rain-water for more than twenty years, which was collected from the leaden roof of a large mansion into a lead cistern at the top of the house, whence it was conveyed in leaden pipes into the yard below, and finally pumped up in leaden pipes into another lead cistern in the kitchen.
I sent some of this water to a most celebrated scientific analytical chemist, and analysed it myself, and we both found lead in it; and I detected lead in the filtered urine, after boiling, in both cases, by sulphuretted hydrogen.
This was most satisfactory. I prescribed for each patient pretty large doses of iodide of potassium, with tonics and a very generous diet, and cut off the supply of lead water. The bowels began to act naturally; the appetite rapidly improved ; and now, in three months, by this treatment alone, both patients are so far recovered as to be able to walk out and enjoy life.
When they began to recover, the albumen gradually reduced
in quantity, as I discovered less lead in the urine, and at last totally disappeared. But the gentleman, who is still unable to use his wrists, has occasionally a little, perhaps one fiftieth part, of albumen.
I am induced to believe, from my own reading, that albumen is very rarely found in the urine of lead-poisoning. I have seen a great many cases, but never detected it before, although I make a point of examining the urine in every case of disease, nor can I account for it satisfactorily. The quantity of albumen, for many weeks, in these cases, was quite as much as I have seen in the worst cases of Bright's disease. The only authority of any note, that I am aware of, is Ollivier, who relates, in 1863, several cases where albumen (he does not state what quantity) was found: and his opinion appears to be that the lead is deposited in the kidneys, in elimination, causing renal degeneration; and hence albuminuria.
AN EXPERIMENTAL OBSERVATION ON HAY FEVER.
BY PROFESSOR BINZ, OF BONN.
FROM what I have observed of recent English publications on the subject of hay fever, I am led to suppose that English authorities are inaccurately acquainted with the discovery by Professor Helmholtz, as far back as 1868, of the existence of uncommon low organisms in the nasal secretions in this complaint, and of the possibility of arresting their action by the local employment of quinine. I therefore purpose to republish the letter in which he originally announced these facts to myself, and to add some further observations on this topic. The letter is as follows.1
"I have suffered, as well as I can remember, since the year 1847, from the peculiar catarrh called by the English 'hay fever,' the speciality of which consists in its attacking its victims regularly in the hay season (myself between the 20th May and the end of June), that it ceases in the cooler weather, but on the other hand quickly reaches a great intensity if the patients expose themselves to heat and sunshine. An extraordinarily violent sneezing then sets in, and a strongly corrosive thin discharge, with which much epithelium is thrown off. This increases, after a few hours, to a painful inflammation of the mucous membrane and of the outside of the nose, and excites fever with severe headache and great depression, if the patient cannot withdraw himself from the heat and the sunshine. In a cool room, however, these symptoms vanish as quickly as they had come on, and there then only remains for a few days a lessened discharge and soreness, as if caused by the loss of epithelium. I remark, by the way, that in all my other years I had very little tendency to catarrh or catching cold, while the 1 Cf. Virchow's Archiv, vol. xlvi. p. 100.
hay fever has never failed during the twenty-one years of which I have spoken, and has never attacked me earlier or later in the year than the times named. The condition is extremely troublesome, and increases, if one is obliged to be much exposed to the sun, to an excessively severe malady.
"The curious dependence of the disease on the season of the year suggested to me the thought that organisms might be the origin of the mischief. In examining the secretions I regularly found, in the last five years, certain vibrio-like bodies in it, which at other times I could not observe in my nasal secretion.
They are very small, and can only be recognised with the immersion-lens of a very good Hartnack's microscope. It is characteristic of the common isolated single joints that they contain four nuclei in a row, of which two pairs are more closely united. The length of the joints is 0.004 millimetre. Upon the warm objective-stage they move with moderate activity, partly in mere vibration, partly shooting backwards and forwards in the direction of their long axis; in lower temperatures they are very inactive. Occasionally one finds them arranged in rows upon each other, or in branching series. Observed some days in the moist chamber, they vegetated again, and appeared somewhat larger and more conspicuous than immediately after their excretion. It is to be noted that only that kind of secretion contains them which is expelled by violent sneezings; that which drops slowly does not contain any. They stick tenaciously enough in the lower cavities and recesses of the nose.
"When I saw your first notice respecting the poisonous action of quinine upon infusoria, I determined at once to make an experiment with that substance, thinking that these vibrionic bodies, even if they did not cause the whole illness, still could render it much more unpleasant through their movements and the decompositions caused by them. For that reason I made a neutral solution of sulphate of quinine, which did not contain much of the salt (1800), but still was effective enough, and caused moderate irritation on the mucous membrane of the nose. I then lay flat on my back, keeping my head very low, and poured with a pipette about four cubic centimetres into both nostrils. Then I turned my head about, in order to let the liquid flow in all directions.