CASES FROM PRACTICE. CLINICAL NOTES OF CASES RECENTLY TREATED IN THE GENERAL HOSPITAL, CALCUTTA. By W. J. Palmer,
M.D., F.E.C.S.L., Assistant, Presidency General Hospital. In these days, when so much intellectual energy is expended natural history of disease," on the study of what is called the when the more obtruse details of chemical and spectroscopical analysis are rigorously applied to the discovery of alterations in tlie fluids of the body, both healthy and diseased ; when the highest magnifying powers of onr microscopes arc zealously applied to unravel minute pathological changes; and again when the thermometer, the ophthalmoscope, sphygmograph, the laryngoscope, &e., &c., are rapidly becoming recognised as aids to correct diagnosis, not less necessary to us in our day than First
"
the stethescope was to our fathors, it is not surprising that the great end of all our learning, viz., the euro of disease, or the allevintion of suffering, should appear to be somewhat overlooked and forgotten; a visit, however, to the wards of our hospitals will suffice to reveal that many new and valuable discoveries are constantly being made and applied to the treatment of disease, and also afford strong evidence that therapeutics is not less successfully pursued than any other branch of medical study. A few examples in illustration may not be considered unworthy of publication. Bromine and the bromides were scarcely known as therapeutic agents, until the last few years, during which time bromide of potassium has gained a great reputation as a nervine sedative ; its marvellous influence in some forms of epilepsy has been amply discussed, and fully brought to notice, but very recently the curativo effccts of this salt, in cases of delirium tremens or acute alcoholism, have appeared so remarkable and worthy of observation, that I am desirous to bring to noticc the results of its action on some cases of that disease treated in this hospital, during the past few months. The first case was that of a well-built muscular young man ; he was brought to hospital early one morning in February, in such a violent condition, that it was considered advisable to place him at once in a room fitted with iron-bar-doors, which is kept for such patients. He shouted and screamed incessantly ; tore the clothes on his back into tatters, and broke every breakable article within his reach ; his arms, face, and legs soou became bruised and excoriated by rough contact against the bars of the doors ; in short, he behaved generally in as wild a mdnner as is ever seen. lie could at any time be subdued and made quiet for a few seconds by the influence of a commanding eve and voice, but he again relapsed into his former wild and unmanageable condition.
one
His medical history was never there was reason to bclievo that of indulging to cxcess habitually, depressed by misfortune, he had
made out quite satisfactorily, he had not been in the habit but having become suddenly drunk deeply to drown his
cares.
In addition to the usual treatment of fluid
foods,
ho
was
11G
THE INDIAN MEDICAL GAZETTE.
ordered a drachm of bromide of potassium immediately, to be followed by half a drachm every two bours. The effect of this was marvellous ; by midday be was subdued ; by four p.m., ho was quiet ; ho slept the whole night, and in the morning was only suffering from debility, being perfectly quiet and reasonable. This was a very favourable case for the effects of the remedy. Case II was a large man of bloated appearance, beyond the prime of life ; he was admitted into hospital before the delirium was so far advanced as in the above case ; within twenty-four hours, however, he became equally wild and unmanageable ; the same treatment was adopted, but the good effects of the bromide did not become apparent until thirty-six hours after he had commenced taking it, and he was not restored to tranquility until the third day. Of the remaining eight cases treated, only two others were as severe as the above two ; the beneficial and sedative effects of the remedy were seldom so rapidly developed as in the first case, and seldom so long delayed as in the second. In a disease of this kind, it is scarcely possible to find any precise similarity in the effects of remedies ; for the continued use of alcohol leads, in many persons at least, to increased tolerance of it. There is reason to believe that the subject of the second case above quoted, had been in the habit of indulging freely in large quantities of brandy for a long time previous to his admission ; so that he was suffering, not merely from undue excitability of his nervous system, but all the functions of his body had become thoroughly deranged, his excreting and secreting glands wero also more or less disorganised ; hence there was great difficulty, on the one hand, in eliminating the poisoning spirit and absorbing tho remedy, and on the other, in preparing new pabulum for the repair of the damaged nerves by the ordinary processes of digestion and nutrition. The remaining eight cases treated were variously influenced by the remedy, according as the disease was like that presented in case I or II above quoted, but in all of them its beneficial effect appeared to me to be so far superior to that of any other remedy, that I hope others may be induced to give it a fair trial, and make the results of their observations known. Tho plan of giving large doses frequently repeated, appears to be essential to the success of the treatment. 2. The beneficial effects of belladonna where large doses of opium have been taken :? A young man was brought from ono of the ships in the river to the hospital between the hours of six and seven A. sr., on the 8th April, suffering from all tho usual effects of poisoning by opium. It was reported that he had taken about two ounces of laudanum three hours before ; he had been kept from sleeping hitherto by constant walking up and down the deck, iand frequent dashing with cold water ; when, hovvever, these no longer sufficed to keep him awake, he was brought to the hospital. No satisfactory evidence could be obtained whether the man had vomited since he took so large a dose ; he probably had ; still, however, he was so much under the influence of the narcotic, that it was scarcely possible to rouse him by the combined influence of brisk walking, flicking with a wet towel, and splashing with cold water. What was the proper treatment in this case ? Neither emetics nor the stomach-pump could have been of much service, for all the landanum must have long ago been absorbed into the system ; for the same reason no good could be expected from the absorbent action of charcoal. A brisk saline purgative was given immediately, but any good it might effect could not take place for some hours. The desideratum was a medicine which would produce physiological effects antagonistic to those of opium ; until the opposite effects on the system of atropia and morphia were made known to the profession a few years ago through the medium of the American Journal of Medical Science?no better remedy of this kind was known than strong coffee. The following details appear to afford valuable evidence of the usefulness of belladonna in these cases : It was known from former experience that the extract of belladonna in the hospital was good, three doses of a quarter of a grain each having previously caused dryness of the fauces and wide dilation of the pupils in a patient to whom it was given, therefore a quarter of a grain was ordered to be given to our present patient immediately, and to be repeated every half hour. The other means of keeping him awake above alluded to were also continued. After four doses of the belladonna had been administered, the patient appeared better, he still fell asleep while trying to answer a question put to him, and his pupils were mere pin-holes in appearance ; it was, however, thought advisable to give the medicine hourly instead of every half hour, lie continued to improve steadily
[June 1,
1860.
from this time, and by four o'clock p. m. he could be left to walk about and keep himself awake. By 9 p. m., all sleepiness had passed away the belladonna was then omitted, and the had now, however, so far patient was allowed to go to bed. He regained control over himself, that he continued to walk about voluntarily until half-past ten o'clock. He was purged very freely through the night, but slept between times, and the next morning he appeared quite well again, the pupils having recovered their normal size. He remained under observation two davs more, and then left the hospital perfectly recovered. 3. Two cases have lately been under treatment, which illustrate the great advantage of enucleating an eye which has become blind from injury, to prevent total blindness. The frequent occurrence of what is called sympathetic inflammation in the second eye, after one has been injured, has been observed for many years; the removal of foreign bodies or of a degenerated lens from the blind eye, with the object of relieving the secondary inflammation and saving the other, has also been recommended and performed, but the great importance of removing a blind eye as soon as the other becomes in any way affected, has only been quite recently admitted ; that is to say, until very lately it was not clearly perceived, that the degenerative changes which occur in an injured eye almost always lead in some subtle way, not well understood even now, to destructive disease in the sound eye, and further that prompt removal of the useless organ affords immediate relief to this disease. The old operation of extirpation was sufficiently repulsive to cause it to be postponed to the latest possible moment ; the modern one. however, of enucleation or letting the eye-ball slip out of its socket, by dividing successively the mucous membrane, the muscles, and the optic nerve, is so simple and unobjectionable, that the only argument against removing a blind and useless eye is done away with. Ophthalmologists who have paid much attention to this sympathetic disease, recommend that an injured eye should be removed the moment there is evidence that it cannot again become useful as an organ of vision ; if, however, this be considered extreme doctrine, there can, I think, be no doubt about the desirability of removing it as soon as the second eye becomes in any way affected. Case I.?A well-formed, healthy engine-driver received a blow his left eye in April, 1868 ; this caused severe inflammation and ultimate complete loss of sight. In December, the second or right eye became inflamed ; from this time till April, 18G9, he suffered from frequent attacks of severe pain in both eyes, with more or less inflammation in the right; he now applied, and was admitted into hospital suffering from severe pain, and a considerable amount of inflammation in all the tissues of each eye. Temporary relief was obtained by the ordinary treatment ; but the swelling and suffering recurred with still greater severity. Eventually, the left eyo was enucleated; the severe frontal and ocular pain ceased immediately, and as the chemosis of the other eye subsided, his cornea was seen to be ulcerated from the arrest of nutrition caused by the inflamed state of the mucous conjunction, but the iris acted freely, and his sight is improving on
daily.
Case II.?The relief afforded in the other case was still more remarkable; the anxiety and apprehension on the part of the patient, lest he should become quite blind, appears to give place to rest and cheerfulness as soon as the operation is performed ; the very day after the operation, both patients seemed to consider it their trouble that not allowed to go were greatest they about the wards in the light amongst other patients. 4. 7 he remarkable power possessed by the alkaline hyposulphites in arresting the formation of pus in the urinary bladder. VVhenever the bladder fails to empty itself completely
either from inefficient contractile power in itself, as seen incases of spinal injury and disease, or from any impediment in the passages of exit, as the various forms of urethral stricture, the unduly retained urine, being in the presence of mucus and other putresible matter, suffers decomposition ; its urea, by n simple transposition of its molecules and absorption of water, becomes carbonate of ammonia, thns :? C H4 Nj 0 X 2 H2 e = (N II4)? c 9,. This newly-formed product is highly irritating to the mucous surface of the bladder; it thus gives rise to increased blood supply, and formation of cells, which, however, are not gradually built up into the normal scaly epithelium, but are hurriedly thrown off iu the form of pus-cells, constituting that trouble-
June 1, some
CASES FKOM PEACTICE.
I860.]
complication
lent-urine.
of
paraplegia
anil
stricture,
called puru-
Till within tlie last few years, the tedious and troublesome process of washing out the bladder daily with weak acids, by means of the double catheter, was the most elTectual known rnodo of treating these cases. A real improvement in the treatment was made, when chemists procluimed that beuzoic acid given by the stomach was converted into hippuric acid while passing through the system, and also that this acid was excreted through the bladder; this indirect supply of acid to the urine was found to be much more effectual in preventing the formation of pus than any mineral acid previously given had been ; still, however, it was only in very mild cases that it controlled the formation of pus entirely : somo more powerful remedy was still a desideratum, and this has, within the past year, been found in the alkaline hyposulphites. The first case in which I had an opportunity of observing this treatment was so remarkably striking, that it is worthy of mention here, though it occurred in London. An old man, who had been paraplegic for years, was nearly worn out from bed-sores, and the constant drain of from six to ten ounces of pus from the bladder daily. Half a dram of hyposulphite of soda was administered to him every three hours ; after continuing this for six days, his urine became clear, and quite freo from pus or putrescence. This result appeared so marvellous as to be scarcely credible ; the urine, however, continued to be free from pus ; the remedy was now stopped, and after four days there was again as much pus in the urine as ever. This appeared to be good cvideuee that the remedy had caused its disappearance in the first instance; if its re-administration again arrested the formation of pus, this evidence would bo conclusive. Similar doses were then again ordered and with similar results, viz., a total disappearance of pus after four days. The patient was too near death to be materially improved by this treatment, still it would appear that, if the remedy had been administered at au earlier stage, his life must have been pro-
longed.
No caso
so
favourable for trial
as
this has occurred in the
general hospital. One man, however, was admitted in January last, Buffering from three strictures in different parts of his urethra; these caused so much impediment to the passage of
was formed in the bladder to the extent of from four to six ounces daily, Half-drachm doses of hyposulphite of soda were given to him every three hours, and the strictures were treated by gradual dilatation. The amount of in five days it had entirely pus in the urine decreased rapidly, disappeared, though it was six weeks before the patient made What is the rationale of this a perfectly free stream of urine. treatment ? The researches of Pasteur and others have shewn, within the last few years, that a drop of sulphurous acid would cause the immediate arrest of fermentation taking place in a mixture If this particular kind of fermentative of yeast and sugar action is so suddenly arrested, it is not improbable that other kinds are also similarly prevented. It was previously known that although a pure solution of urea in water would not form carbonate of ammonia, yet if a little mucus or other putrescible matter were present, this decomposition would take place. In urine, whether inside the bladder or out of it, putrescible mucus is at all times present and ready to initiate the ammoniacal fermentation unless prevented ; it therefore appears that the presence of sulphurous acid, or a hyposulphite, in the m ine is sufficient to arrest this action. All who have experienced the tediousness and inadequate results of the old mode of to appreciate the great advantreating these cases, will be able to this our therapeutic agents. tage of such au addition as
urine, that pus
>
I
.
117
M.D., F.E.C.S.L., Assistant, Presidency General Hospital. In these days, when so much intellectual energy is expended natural history of disease," on the study of what is called the when the more obtruse details of chemical and spectroscopical analysis are rigorously applied to the discovery of alterations in tlie fluids of the body, both healthy and diseased ; when the highest magnifying powers of onr microscopes arc zealously applied to unravel minute pathological changes; and again when the thermometer, the ophthalmoscope, sphygmograph, the laryngoscope, &e., &c., are rapidly becoming recognised as aids to correct diagnosis, not less necessary to us in our day than First
"
the stethescope was to our fathors, it is not surprising that the great end of all our learning, viz., the euro of disease, or the allevintion of suffering, should appear to be somewhat overlooked and forgotten; a visit, however, to the wards of our hospitals will suffice to reveal that many new and valuable discoveries are constantly being made and applied to the treatment of disease, and also afford strong evidence that therapeutics is not less successfully pursued than any other branch of medical study. A few examples in illustration may not be considered unworthy of publication. Bromine and the bromides were scarcely known as therapeutic agents, until the last few years, during which time bromide of potassium has gained a great reputation as a nervine sedative ; its marvellous influence in some forms of epilepsy has been amply discussed, and fully brought to notice, but very recently the curativo effccts of this salt, in cases of delirium tremens or acute alcoholism, have appeared so remarkable and worthy of observation, that I am desirous to bring to noticc the results of its action on some cases of that disease treated in this hospital, during the past few months. The first case was that of a well-built muscular young man ; he was brought to hospital early one morning in February, in such a violent condition, that it was considered advisable to place him at once in a room fitted with iron-bar-doors, which is kept for such patients. He shouted and screamed incessantly ; tore the clothes on his back into tatters, and broke every breakable article within his reach ; his arms, face, and legs soou became bruised and excoriated by rough contact against the bars of the doors ; in short, he behaved generally in as wild a mdnner as is ever seen. lie could at any time be subdued and made quiet for a few seconds by the influence of a commanding eve and voice, but he again relapsed into his former wild and unmanageable condition.
one
His medical history was never there was reason to bclievo that of indulging to cxcess habitually, depressed by misfortune, he had
made out quite satisfactorily, he had not been in the habit but having become suddenly drunk deeply to drown his
cares.
In addition to the usual treatment of fluid
foods,
ho
was
11G
THE INDIAN MEDICAL GAZETTE.
ordered a drachm of bromide of potassium immediately, to be followed by half a drachm every two bours. The effect of this was marvellous ; by midday be was subdued ; by four p.m., ho was quiet ; ho slept the whole night, and in the morning was only suffering from debility, being perfectly quiet and reasonable. This was a very favourable case for the effects of the remedy. Case II was a large man of bloated appearance, beyond the prime of life ; he was admitted into hospital before the delirium was so far advanced as in the above case ; within twenty-four hours, however, he became equally wild and unmanageable ; the same treatment was adopted, but the good effects of the bromide did not become apparent until thirty-six hours after he had commenced taking it, and he was not restored to tranquility until the third day. Of the remaining eight cases treated, only two others were as severe as the above two ; the beneficial and sedative effects of the remedy were seldom so rapidly developed as in the first case, and seldom so long delayed as in the second. In a disease of this kind, it is scarcely possible to find any precise similarity in the effects of remedies ; for the continued use of alcohol leads, in many persons at least, to increased tolerance of it. There is reason to believe that the subject of the second case above quoted, had been in the habit of indulging freely in large quantities of brandy for a long time previous to his admission ; so that he was suffering, not merely from undue excitability of his nervous system, but all the functions of his body had become thoroughly deranged, his excreting and secreting glands wero also more or less disorganised ; hence there was great difficulty, on the one hand, in eliminating the poisoning spirit and absorbing tho remedy, and on the other, in preparing new pabulum for the repair of the damaged nerves by the ordinary processes of digestion and nutrition. The remaining eight cases treated were variously influenced by the remedy, according as the disease was like that presented in case I or II above quoted, but in all of them its beneficial effect appeared to me to be so far superior to that of any other remedy, that I hope others may be induced to give it a fair trial, and make the results of their observations known. Tho plan of giving large doses frequently repeated, appears to be essential to the success of the treatment. 2. The beneficial effects of belladonna where large doses of opium have been taken :? A young man was brought from ono of the ships in the river to the hospital between the hours of six and seven A. sr., on the 8th April, suffering from all tho usual effects of poisoning by opium. It was reported that he had taken about two ounces of laudanum three hours before ; he had been kept from sleeping hitherto by constant walking up and down the deck, iand frequent dashing with cold water ; when, hovvever, these no longer sufficed to keep him awake, he was brought to the hospital. No satisfactory evidence could be obtained whether the man had vomited since he took so large a dose ; he probably had ; still, however, he was so much under the influence of the narcotic, that it was scarcely possible to rouse him by the combined influence of brisk walking, flicking with a wet towel, and splashing with cold water. What was the proper treatment in this case ? Neither emetics nor the stomach-pump could have been of much service, for all the landanum must have long ago been absorbed into the system ; for the same reason no good could be expected from the absorbent action of charcoal. A brisk saline purgative was given immediately, but any good it might effect could not take place for some hours. The desideratum was a medicine which would produce physiological effects antagonistic to those of opium ; until the opposite effects on the system of atropia and morphia were made known to the profession a few years ago through the medium of the American Journal of Medical Science?no better remedy of this kind was known than strong coffee. The following details appear to afford valuable evidence of the usefulness of belladonna in these cases : It was known from former experience that the extract of belladonna in the hospital was good, three doses of a quarter of a grain each having previously caused dryness of the fauces and wide dilation of the pupils in a patient to whom it was given, therefore a quarter of a grain was ordered to be given to our present patient immediately, and to be repeated every half hour. The other means of keeping him awake above alluded to were also continued. After four doses of the belladonna had been administered, the patient appeared better, he still fell asleep while trying to answer a question put to him, and his pupils were mere pin-holes in appearance ; it was, however, thought advisable to give the medicine hourly instead of every half hour, lie continued to improve steadily
[June 1,
1860.
from this time, and by four o'clock p. m. he could be left to walk about and keep himself awake. By 9 p. m., all sleepiness had passed away the belladonna was then omitted, and the had now, however, so far patient was allowed to go to bed. He regained control over himself, that he continued to walk about voluntarily until half-past ten o'clock. He was purged very freely through the night, but slept between times, and the next morning he appeared quite well again, the pupils having recovered their normal size. He remained under observation two davs more, and then left the hospital perfectly recovered. 3. Two cases have lately been under treatment, which illustrate the great advantage of enucleating an eye which has become blind from injury, to prevent total blindness. The frequent occurrence of what is called sympathetic inflammation in the second eye, after one has been injured, has been observed for many years; the removal of foreign bodies or of a degenerated lens from the blind eye, with the object of relieving the secondary inflammation and saving the other, has also been recommended and performed, but the great importance of removing a blind eye as soon as the other becomes in any way affected, has only been quite recently admitted ; that is to say, until very lately it was not clearly perceived, that the degenerative changes which occur in an injured eye almost always lead in some subtle way, not well understood even now, to destructive disease in the sound eye, and further that prompt removal of the useless organ affords immediate relief to this disease. The old operation of extirpation was sufficiently repulsive to cause it to be postponed to the latest possible moment ; the modern one. however, of enucleation or letting the eye-ball slip out of its socket, by dividing successively the mucous membrane, the muscles, and the optic nerve, is so simple and unobjectionable, that the only argument against removing a blind and useless eye is done away with. Ophthalmologists who have paid much attention to this sympathetic disease, recommend that an injured eye should be removed the moment there is evidence that it cannot again become useful as an organ of vision ; if, however, this be considered extreme doctrine, there can, I think, be no doubt about the desirability of removing it as soon as the second eye becomes in any way affected. Case I.?A well-formed, healthy engine-driver received a blow his left eye in April, 1868 ; this caused severe inflammation and ultimate complete loss of sight. In December, the second or right eye became inflamed ; from this time till April, 18G9, he suffered from frequent attacks of severe pain in both eyes, with more or less inflammation in the right; he now applied, and was admitted into hospital suffering from severe pain, and a considerable amount of inflammation in all the tissues of each eye. Temporary relief was obtained by the ordinary treatment ; but the swelling and suffering recurred with still greater severity. Eventually, the left eyo was enucleated; the severe frontal and ocular pain ceased immediately, and as the chemosis of the other eye subsided, his cornea was seen to be ulcerated from the arrest of nutrition caused by the inflamed state of the mucous conjunction, but the iris acted freely, and his sight is improving on
daily.
Case II.?The relief afforded in the other case was still more remarkable; the anxiety and apprehension on the part of the patient, lest he should become quite blind, appears to give place to rest and cheerfulness as soon as the operation is performed ; the very day after the operation, both patients seemed to consider it their trouble that not allowed to go were greatest they about the wards in the light amongst other patients. 4. 7 he remarkable power possessed by the alkaline hyposulphites in arresting the formation of pus in the urinary bladder. VVhenever the bladder fails to empty itself completely
either from inefficient contractile power in itself, as seen incases of spinal injury and disease, or from any impediment in the passages of exit, as the various forms of urethral stricture, the unduly retained urine, being in the presence of mucus and other putresible matter, suffers decomposition ; its urea, by n simple transposition of its molecules and absorption of water, becomes carbonate of ammonia, thns :? C H4 Nj 0 X 2 H2 e = (N II4)? c 9,. This newly-formed product is highly irritating to the mucous surface of the bladder; it thus gives rise to increased blood supply, and formation of cells, which, however, are not gradually built up into the normal scaly epithelium, but are hurriedly thrown off iu the form of pus-cells, constituting that trouble-
June 1, some
CASES FKOM PEACTICE.
I860.]
complication
lent-urine.
of
paraplegia
anil
stricture,
called puru-
Till within tlie last few years, the tedious and troublesome process of washing out the bladder daily with weak acids, by means of the double catheter, was the most elTectual known rnodo of treating these cases. A real improvement in the treatment was made, when chemists procluimed that beuzoic acid given by the stomach was converted into hippuric acid while passing through the system, and also that this acid was excreted through the bladder; this indirect supply of acid to the urine was found to be much more effectual in preventing the formation of pus than any mineral acid previously given had been ; still, however, it was only in very mild cases that it controlled the formation of pus entirely : somo more powerful remedy was still a desideratum, and this has, within the past year, been found in the alkaline hyposulphites. The first case in which I had an opportunity of observing this treatment was so remarkably striking, that it is worthy of mention here, though it occurred in London. An old man, who had been paraplegic for years, was nearly worn out from bed-sores, and the constant drain of from six to ten ounces of pus from the bladder daily. Half a dram of hyposulphite of soda was administered to him every three hours ; after continuing this for six days, his urine became clear, and quite freo from pus or putrescence. This result appeared so marvellous as to be scarcely credible ; the urine, however, continued to be free from pus ; the remedy was now stopped, and after four days there was again as much pus in the urine as ever. This appeared to be good cvideuee that the remedy had caused its disappearance in the first instance; if its re-administration again arrested the formation of pus, this evidence would bo conclusive. Similar doses were then again ordered and with similar results, viz., a total disappearance of pus after four days. The patient was too near death to be materially improved by this treatment, still it would appear that, if the remedy had been administered at au earlier stage, his life must have been pro-
longed.
No caso
so
favourable for trial
as
this has occurred in the
general hospital. One man, however, was admitted in January last, Buffering from three strictures in different parts of his urethra; these caused so much impediment to the passage of
was formed in the bladder to the extent of from four to six ounces daily, Half-drachm doses of hyposulphite of soda were given to him every three hours, and the strictures were treated by gradual dilatation. The amount of in five days it had entirely pus in the urine decreased rapidly, disappeared, though it was six weeks before the patient made What is the rationale of this a perfectly free stream of urine. treatment ? The researches of Pasteur and others have shewn, within the last few years, that a drop of sulphurous acid would cause the immediate arrest of fermentation taking place in a mixture If this particular kind of fermentative of yeast and sugar action is so suddenly arrested, it is not improbable that other kinds are also similarly prevented. It was previously known that although a pure solution of urea in water would not form carbonate of ammonia, yet if a little mucus or other putrescible matter were present, this decomposition would take place. In urine, whether inside the bladder or out of it, putrescible mucus is at all times present and ready to initiate the ammoniacal fermentation unless prevented ; it therefore appears that the presence of sulphurous acid, or a hyposulphite, in the m ine is sufficient to arrest this action. All who have experienced the tediousness and inadequate results of the old mode of to appreciate the great advantreating these cases, will be able to this our therapeutic agents. tage of such au addition as
urine, that pus
>
I
.
117
