the real existence of which seems to be confirmed by the observation of Dr. Ewing, that of a suppurating tube, which from time to time, discharges its contents into the uterine cavity, I doubt the propriety of the operation, under such circumstances. I think that natural canals leading to suppurating cavities, once open to the flow of pus, seldom close again, and with an open and patulous uterine orifice, through which the discharge might easily escape, there could be little or no likelihood of the tube becoming so much distended as to endanger life or to give great discomfort to the patient, and in such a case there might be a possibility of cure under proper treatment, without resorting to the rather hazardous extreme of an operation. As to the controlling influence which decrees that one case of tubal disease shall by a hydro-salpynx, while another is a pyosalpinx, I will suggest that probably the former grows out a simple catarrhal inflammation of the tube communicated from the uterine cavity, resulting in the sealing up or closing of the orifices of the tube by inflammatory products, while the serous exhalations and mucous discharges peculiar to that form of inflammation, might result in a distension or dropsy of the tube. Should the inflammation continue, especially in a subject favoring pyogenesis, this fluid might be absorbed, and its place occupied by rapidly accumulating pus corpuscles. In other instances pus is evidently the fluid primarily occupying the tube. If, however, we are to accept the microbic theory of all pus genesis, (to which I reluctantly incline), the probabilities are that the staphylococus pyogenus, finds access into the tube either from the uterine cavity or through lymph channels, and by their presence, or that of their ptomaines, products acting either locally or through the blood, invite a rapid emigration of leucocytes or white corpuscles from the blood to the diseased organ, thereby distending it and producing pyo-salpynx. Dr. Douglas: Do you not, doctor, concede the local genesis of pus corpuscles under the "inflammatory stimulus?" Dr. Cain: No, if we are to accept and follow after the most modern teaching. I would discard the the Virchow theory of local pus genesis from fixed tissue cells, and say, that owing to 56 ORIGINAL COMMUNICATIONS-CUTTER. some influence exerted by the staphylococus pyogenus or the alkaloid ptomaines produced by it, there is a rapid development and migration of leucocytes from the blood to the seat of disease, and that all pus cells are from the blood, and are migrated leucocytes. TROPHOPATHY IN THE FATTY AND FIBROID DEGENERATIONS. JOINT PAPER.* BY EPHRAIM CUTTER, M. D., LL. D., Gold Medallist of the Society of Science, Letters and Arts, London; Author of the American Institute of Micrology, etc., etc., AND JOHN ASHBURTON CUTTER, M. D., B. SC., Formerly Attending Physician to Dispensary No. 3, of the International Medical Missionary Society. INTRODUCTION. The animus of this contribution is the belief of the writers that Trophopathy (Trophos-food, pathos-disease), has more to do with the cause of the so-called incurable diseases than the profession gives credit to, and to show that our belief is founded on facts, we will immediately proceed to the consideration of the subject in the concrete, to-wit: The reading of some histories of patients that have been under our care. CASE-HISTORIES. CASE I. A little more than four years ago, a gentleman brought to our office a friend, who appeared to the Senior writer to be almost moribund; indeed, he feared that the man would die in the office. Examination showed the case to be suffering from an enlarged heart, a fibroid liver and Bright's disease of the kidneys; the urine contained albumen, casts and fatty epithelia. We will here make note that in our study of patients for the *Read before the Section of Practice of Medicine, Materia Medica and Physiology of the American Medical Association, at its Fortieth Annual Meeting, 1889. By the Junior writer. evidence of Bright's disease, little care is paid whether the casts are fatty, hyaline, waxy, etc. Amyloid bodies are usually found in the urine when the kidney is first breaking down. But we consider no case to be full-fledged Bright's disease, till albumen, casts and fatty epithelia are found. There may be any one of these three, or any two; it is a common matter to find such cases which are just hovering along the margin of health and disease and yet not full-fledged, so to speak. This patient, desperate as his case was, went under the treatment to be further on described, and recovered and would be here to-day for your examination if possible; his heart, liver and kidneys are now doing healthy work. CASE II. About one year before his death, America's greatest laryngologist, Dr. Louis Elsberg, came under the care of the senior writer. His case was one of Bright's disease with all the It signs as before enumerated. He was placed on a rigid diet and would take no medicine. This regimen he followed out for months and all of the morphological and chemical evidences of his disease disappeared from the urine. He was then allowed some lee-way in his diet. The senior writer called one morning early at his office and found Dr. Elsberg at breakfast eating freely of all the starches and sugars that were placed before him. was said to him, "Elsberg, if you persist in this reckless diet, you will kill yourself." The medical world knows how he died supdenly of pneumonia, perhaps Bright's disease of the lungs. CASE III. About four years ago, a millionaire was treated for two month's for Bright's disease of the kidneys and lungs. At the expiration of that time feeling too poor to continue under a physician's care, he undertook the direction of his case; ate wrongly, overworked, and while superintending some repairs in his house, was poisoned by sewer gas. The doctor was sent for again, but the good work that had been done for him in the two month's of treatment was thoroughly undone and he died. CASE IV. June, 1880, the senior writer called to see primipara in a non-professional way. She was in three weeks of her expected confinement, and to his horror he found her bloated, and on examination the urine proved to be heavily albuminous 58 ORIGINAL COMMUNICATIONS-CUTTER. and contained casts and fatty epithelia. She was placed on rigid diet, but labor came on in thirty-six hours and she was easily delivered of her child, which weighed but three and a half pounds. The placenta was covered with numerous elevations which under the microscope proved to be made up of plates of cholesterine. Two days after confinement, a steam fire engine came to the corner near the house in which she lived and fastening to a hydrant commenced to pump. The noise worried her; entreaties to the engineer to desist were of no avail and the poor woman went into convulsions. The senior writer writer arrived soon afterwards. She was kept under the influence of ether and was purged, but the convulsions did not cease till thirty-six hours had elapsed. She was placed on a diet of beef tea; no medicine. Later on, broiled steaks were given her. The face was drawn to the side and her brain was very weak. The regimen was persisted in till the pathological evidences were removed from the urine and since this time her diet has been two-thirds animal and one-third vegetable food. She has borne two more children both of whom are much more rugged than the first. CASE V. Mrs. Blank went on treatment about four years ago, and on thorough examination was found to be sick with fibrous consumption, Bright's disease, and a small fibroid tumor of the womb about the size of a man's fist. The evidences of Bright's disease disappeared; the fibroid tumor has gone and we can say that she is cured of her fibrous consumption if there is such a thing as a cure of a chronic disease. She is now passing through the change of life and can by no means be called a thoroughly well woman, yet if she is here to-day, I think you will find on talking with her that she considers the diseased condition above described, as not troubling her now. CASE VI. Three years ago, a young married woman came to our office and was found to be sick with Bright's disease of the kidneys, indeed it is rare to find urine that contained as many casts and of all kinds as hers did. She was placed on treatment and in one month's time the pathological evidences had nearly ali disappeared. She persevered and is to-day enjoying good health. work to make her After three months CASE VII. The Rev., treasurer of a great Missionary Society came under our care at about the same time as Case VI. He also had Bright's disease. He went on treatment, though keeping at his work. His loss of flesh and strength at first, greatly disturbed his wife, and it was hard believe that he should be held to the plans. he took a vacation in Maine, still pursuing the plans of diet and medication, and in the fall came back to work. This case may be called in progress. His occupation is a very laborious one, tiring to the mind and full of worry. At the present he is under the plan of two-thirds animal and one-third vegetable food, eating one kind of meat and one vegetable at a meal. June 18, 1889, his specimen presented no casts, no fatty epithelia and but a trace of albumen. Yet he tells us that he has never in his life worked so hard as the last month and wonders that he holds on as well as he does. CASE VIII. In 1877, the senior writer saw in consultation a lady who was said to be dying of Bright's disease and that the attending physicians wished blood to be transfused into her veins. She was as white as the sheets she lay between, was vomiting and her urine confirmed the diagnosis made by the attendants. Before going back to Boston to get instruments to transfuse with, the senior writer sat down beside her and taking a diet list from his pocket asked her if she could eat the different foods as named thereon. She said no till tripe was mentioned, and replied that she could eat that. So ordered. On returning with instruments the next day he was told that there was no need of operating, as the patient had retained the tripe and was better. In March, 1886, we were in this neighborhood operating on a case of uterine fibroid. The father expressed a desire to the son to see if this patient was alive, and on calling on her attending physician learned that she was, and on visiting her, found a large florid woman who said "that she was not much for work, but was far from being dead." It seems that she lived on tripe and milk warm from the cow and other animal foods for over two years. By that time the evidences of Bright's disease had gradually and wholly disappeared from the urine. |