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Notes and Queries.

This department will be devoted, as its name implies, to such items of special inquiry as may be of general interest to the readers of the CLINICAL RECORD. Many questions daily arise in connection with the College or the profession at large, or in the domain of medical science, whose solution might interest a large number of medical men. We invite communications from all those who desire information which may be in our power to impart, and we shall endeavor to make this department of our journal one of its most attractive features.

GRADUATE OF 1856.-"What has become of the portrait of the late Professor Charles D. Meigs, which was painted for the Class and presented to the trustees of the College many years ago? Why is it not placed on the wall of the hospital lecture-room with the portraits of the other professors?" The portrait is now in the possession of Dr. John Forsyth Meigs, a well-known practitioner of this city and son of the old professor, who based his claims to it on the ground that it was a personal gift from the class to his father. Many of the graduates of the school who were pupils of the latter-some of them participants on the occasion-have asked the same question as our correspondent, and members of the Board of Trustees have expressed surprise at its absence from the walls of the lecture-room, believing : as they did that it was painted for the College. ¦ The distinguished artist, S. B. Waugh, who painted it, has always been under the latter impression. Dr. Mitchell H. Picot, now of Geneva, New York, who acted as spokesman of the Class on the occasion of the presentation, writes to say that it was a personal token of affection from them to Professor Meigs, not to the College. We hope that, sooner or later, the portrait, either original or copied, may by donation or purchase find a place alongside the other professors of the past, who in their individual and united strength gave to the College a firm and enduring reputation as a school of sound medical teaching.

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E. E. S.-"I am thinking of going on an exploring party to explore Central Western Africa. Can you suggest any way that I can benefit the cause of the profession at large, if I should decide to go." The personal exThe personal experience of an intelligent traveller in such distant fields is always fruitful of good results to himself and others, and we should think a professional man might glean many interesting facts in regard to surgical instruments, medicines, the customs of the people, etc. Some

times from a land of civilization like our own modern advanced ideas may be projected,

No. II OF THE CLINICAL RECORD,

To be published February 15th, 1880, will contain, among a great variety of interesting matter, the following:

Medical Clinic, by Professor Roberts Bartholow, M.D., LL.D. (Phonographic report.) Surgical Clinic, by Professor Samuel D. Gross, M.D., LL.D., D. C.L., Oxon.

Lecture on Death, by the late Professor
Robley Dunglison, M.D., LL.D.
Notes on Hydrobromic Ether, the New
Anæsthetic.

Notes and Queries.
College News, etc., etc.

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Feb. 16, 1880.

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CASE I.—THE SIGNIFICANCE OF JAUNDICE, ITS DANGERS;

IMPORTANCE OF PROMPT TREATMENT, MANAGEMENT
OF CHRONIC HEPATIC DERANGEMENT.

CASE II.—ETIOLOGY OF EMPHYSEMA, ITS RELATION TO
ACUTE BRONCHITIS. IMPORTANCE OF PROPHYLAXIS.

changes in the complexion, the urine, and the blood? The integument of this man's body, generally, has not the appearance of health, but is a dirty fawn color. Observe that it is not the dark greenish and olive hue of jaundice, properly speaking. We have said that this indicates a degenerative change of the liver. How shall we account for it here? He has not been a hard drinker, but he has been a steady drinker for years, from day to day, and from year to The year, although he is still a young man. Constant stimulation by alcohol has finally produced a condition of things of grave import. Let us for a moment consider the state of the

TREATMENT OF BRONCHIAL ASTHMA. CASE III.—HYSTERIA, AND ITS TREATMENT. CASE IV.--HEMIPLEGIA, SYPHILOMA OF BRAIN, LOCAL-intestinal canal, and the functions of digestion IZATION OF LESION.

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and assimilation. His appetite is poor, he complains of indigestion and flatulence. He is restless at night. What is very significant, gentlemen, is that his stools are of the color of pine wood. What is the color and appearance of a perfectly normal stool? this is a question that I often ask students, and is a point too often neglected by medical men. A normal stool will not have this pine-wood color, but is of a dark, brown appearance, from the presence of bile. The clay-colored, or white stools, of hepatic disease, indicate that certain constituents of the bile are absent, which should normally pass into the dejections.

fault that it is not capable of performing its functions. What is the significance of this fact? and what is the danger?

GENTLEMEN: I think the most casual inspection of this young man will show you that he is laboring under hepatic derangement. He has had several attacks of jaundice at various times, the results of which are still seen in his sallow complexion; although there is no marked jaun- He says that some time ago the discharges were dice this morning, his face shows the evidence of a lead color, at which time we may assume of chronic biliary derangement. A passing that no bile whatever was present. What, then, attack of intense jaundice may depend upon becomes of the bile pigment? We found it in very casual agencies, and, as a rule, indicates the urine, being secreted or separated by the only a functional disturbance of the liver; but kidneys from the blood, where it had accumuwhere the discoloration of the skin remains per-lated. This indicates that the liver is so far at manently, it indicates always a change in the structure of that organ. I wish to emphasize this fact, which was originally pointed out by Graves, and since then has received much attention. The point is, that, in some forms of biliary derangement, there may not be marked jaundice of the general surface, but only a fawn color of the skin; whereas most intense jaundice may be due to causes that are temporary, and fugitive in their character. The light fawn color, then, would indicate that the biliary trouble is structural and permanent, and not transitory. This will aid in making our prognosis. This discoloration of the skin is caused by the circulation of the biliary coloring matters in the blood, due to reabsorption of bile from the biliary passages. Besides staining the skin, they make their appearance in excess in the urine, where they may be recognized by the ordinary Gmelin test. (Urine tested by nitric acid, showing a play of colors.)

The problem before us for solution in this patient is: What may be the disorder of the hepatic organs producing or accompanying these

VOL. 1.-2

Suppose a catarrhal condition of the common ducts or the biliary passages of the liver, produces an obstruction to the discharge of the bile into the duodenum, or a gall-stone, or other agency impedes its passage; the blood then reabsorbs the accumulated bile, and the condition of obstructive jaundice appears. Now, recent researches in pathology have shown that there cannot be, for any length of time, an obstruction to the outlet of the bile into the intestinal canal, without there being set up important changes in the structure, which ultimately lead to loss of power by the liver to functionate. Modern researches have shown that the structure of the organ rapidly degenerates, the proper secreting cells undergo fatty change, then atrophy and disappear, and at the same time the connective tissue increases in quantity, both relatively and absolutely. This danger is imminent in all cases of liver disturbance, characterized by jaundice. It will, therefore, not

do to be indifferent to any of the forms of jaun- | of lime and dilute phosphoric acid make a good
dice, if they continue for any length of time. combination. Indeed, the best, in view of its
You will not be doing justice to your patient, ready assimilation, is the phosphate of lime; but,
if you pass it by as of little moment; the skilled
practitioner will treat the case in time, and pre-
vent this areolar hypertrophy and cell degen-
eration, which will, if neglected, go to such an
extent that the organ will be prevented from
performing its functions ever afterwards.

Phos

on account of its insoluble character, the ques-
tion is how to introduce it into the system.
When freshly prepared, it is soluble in lactic
acid. In this form it is readily absorbed, and
promotes digestion and assimilation.
phorus, you know, exerts an elective action
upon the connective tissue of the liver; for in
phosphorus poisoning we find the hepatic con-
nective tissue in the state of fatty degeneration
and destructive change. The metals, also, are
generally thrown out by this channel, and in
poisoning by the metallic salts, such as copper
or antimony, the substance may be detected in
this organ. In medico-legal cases, we always
secure the liver, in order to examine it for

What has been the pathological condition here? The habits of life of this man and the chronic indigestion have led to duodenal catarrh. This was followed by swelling of the mucous lining of the bile-ducts, which is continuous with that of the intestinal surface. First, we have simple catarrhal condition of the bile passages, and jaundice (catarrhal jaundice); secondly, we have the mucous inflammation and swelling preventing the exit of the bile, poison. Arsenic particularly acts upon the and, hence, interference with the function of the liver. What is the effect? In the light of late investigations by Charcot and Legg, we know that this cannot continue for any length of time without the occurrence of organic change. His steady drinking, moreover, has favored contraction of the liver, which is demonstrated by physical examination; percussion shows that the liver is decidedly contracted, the area of dulness is reduced materially, and does not extend below the ribs.

Shall we conclude that our remedies will be unable to bring about a change? Can we do nothing for this cirrhotic liver? You remember that I told you the other day that nature has been bountiful in her gifts; that every individual is provided with more liver, more lung, more brain, than is necessary for his ordinary exist ence. This is well exemplified in the reproductive function. One testicle is sufficient for impregnation, as much so as two, or, indeed, a dozen for that matter.

hepatic structures, and after arsenical poisoning
it may be detected in all the viscera, but is prin-
cipally found in the liver. With this in view,
he shall have two drops of Fowler's solution
three times a day, given after meals.

B. Syrup. calcii lacto-phosphatis .
Liq. potassii arsenitis

S. Ter in die.

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We employ the arsenic in order to act upon the nutrition of the liver, and for its specific effect upon the connective tissue.

A most important part of the treatment in hepatic disorders is careful regulation of the diet. Here is the problem. Given a damaged liver, what shall be the alimentation in order to secure digestion and assimilation? Evidently his diet should mainly consist of such articles of food as do not require bile for their assimilation. Now, shall we direct him to eat fatty, saccharine, or starchy articles? If we understand anything whatever about the action of the different secretions upon the function of digestion in the upper portion of the small intestine, we know that the bile emulsifies fats and favors their absorption. it also prevents fermentation in the starchy and saccharine elements. We must, therefore, give this patient substances that are converted into peptones in the stomach, and are thus readily absorbed. He shall have milk, fresh meat, eggs, and the succulent vegetables, such as contain but little sugar or starch (spinach, cabbage, cauliflower, etc.).

This fact is equally true of the secreting structure of the liver; a considerable part of it may be destroyed without fatally interfering with its functions. In this patient, if there be a sufficient quantity of healthy liver substance remaining to carry on the function of the organ, the interference of the morbid process being removed and its progress arrested, we may succeed in restoring the man to comparative health. We will, therefore, treat this patient. The problem is to restore the production of bile, and We will direct our patient to keep up the secure the discharge into the intestinal canal. treatment systematically. It would be folly for How shall we proceed? What will arrest this him to expect that in a few days or weeks we over-production of connective tissue, which is will be able to entirely restore him; especially contracting upon the liver cells and causing if he disobey our instructions in regard to alcotheir destruction? We have therapeutic agents holic drinks, which must be absolutely disconthat will do this. We may use the phosphates tinued. Unless he faithfully carries out his and phosphites, particularly the former, with a treatment he will go on from bad to worse ungood prospect of success. The lacto-phosphate | til the organ will be irretrievably damaged.

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