nourishment (milk and Valentine's meat juice) in the last twentyfour hours than in two days preceding.

Oct. 30th.-Had two or three convulsive seizures during night, but they were slight in comparison with those of two nights ago. Vomited suddenly and profusely this morning throwing up all the milk she had taken. Vomiting projectile in character. Iodoform 6x continued.

November 3d.-Last night child had convulsions again. This morning she lies in a stupor, with head retracted, pupils dilated to such an extent that the iris is a mere line; blank, vacant expression in eyes. Cannot be roused. Cannot understand anything that is said to her. Takes a fair quantity of nourishment. Bowels are now constipated. Vomits at intervals. As this case had now had iodoform in the 6x trituration for a week without satisfactory improvement, the preparation was changed and a powder of the second decimal trituration was given every two hours.

November 5th.-Convulsions again last night. Same general condition, pulse small and feeble. Have not been able to keep any temperature record as child has been so irritable and so intolerant of being touched at all, that it has been impossible to take the temperature, but it has not been high. While I have never been present during any of the convulsions, yet judging from her apparent temperature, at times when I have seen her, I do not think it has been much above 101° or 102° at any time. Head very much retracted and boring in pillow.

This morning when I entered the house I found the mother weeping at the child's bedside, I asked her what she was crying for, and she said, "I am crying because I know my little girl will never get well. I must tell you something that I have not told you before. Since my little one has been sick, all my relatives and friends have been coming every day to inquire how she was getting on, and this one would say, why don't you have Dr. So and So come to see her, and another would say, why don't you get my doctor, and so, without letting you know anything about it, I have had altogether eight other doctors here beside yourself. They have all concurred in the diagnosis of tubercular meningitis but they have all said that she would surely die." Among those that she mentioned having consulted, one was a professor in the New York Post-Graduate Medical School, and another, whom she said had gone away just before I came in, was a professor of the diseases of children in one of the foremost old school medical colleges of this city. One doctor who had been connected with the case at first, had stopped in to inquire

about the child, and, somewhat surprised at finding her still alive, had comforted her with the prediction that if, perchance, she should survive this sickness, it would have been better for her had she died, as she would be left either idiotic, or paralyzed, or deformed.

As the iodoform given in the form of triturations had thus far failed to produce any material improvement, I concluded now that I would use it after the method which had proved successful in my former case. I therefore directed that the child's head be shaved. The mother was very reluctant to do this, as she was firmly convinced that the child was going to die, and she had beautiful golden hair, and the mother said it would look so awful to see her in her coffin with her head all shaved clean. "Well," I said, "if you feel so sure she will die, leave a rim of it across the front of her head and have it shaved from the vertex backward." This was done. An ointment of iodoform and vaseline, one drachm to the ounce, was then made up and about one drachm of this preparation was directed to be rubbed into the scalp twice a day. It was to be thoroughly rubbed in, till it had all disappeared.

The rubbing of the head seemed to have a soothing, quieting effect and the child would usually sleep for a few hours after it. From the time this treatment was begun, the child had no more convulsions. She slept more quietly and took more food, and the general condition gradually improved.

November 15th.-Consciousness is beginning to return. The child recognizes those about her and seems to understand what is said to her, though she does not answer sensibly. Smiles when spoken to, but is apt to make some foolish answer to questions. Begins to want to sit up in bed and the head is no longer retracted as heretofore.

November 21st.—Found child dressed. Wanted to get up this morning, but was too weak to stand. Mother dressed her to humor her and let her sit for awhile in the rocking chair. Mind is getting brighter every day. Inunctions continued.

November 27th.-Child can walk about. rapidly. Answers questions all right now. strength daily.

Mind is clearing Gaining flesh and

Dec. 4th.-Convalescence progressing nicely. Head is rubbed but once a day now.

Dec. 11th.-No symptoms remain. Child is well. Dismissed,

cured.

June 11th, 1895.-Saw this child to-day and she is absolutely well. Mother says she has never been in better health in her life.

From the time the first powder of iodoform was given until the case was dismissed cured, not a single dose of any other remedy was used with the exception that on two occasions when the bowels had become very much constipated, a dose of castor oil was administered to relieve them.

In Goodno's Practice, which has been published since the last case was treated, the writer of the article on tubercular meningitis, Dr. Clarence Bartlett, says: "Among remedies, iodoform stands at the head. This drug has in several instances (I have twice observed it to do so) produced symptoms indistinguishable from meningitis. It is customary with the old school physicians to shave the scalp and apply an iodoform ointment for two or three days. The internal administration of the drug will probably do as much if not more good. I have used it in the second decimal trituration giving one tablet every two hours." It was with this idea in mind that I administered the remedy internally, but the best results were produced when it was applied by the inunction method.

T

URINALYSIS.*

BY JOSEPH C. GUERNSEY, A. M., M. D.

Philadelphia, Pa.

HERE are all kinds of amusements for all kinds of people, from the building blocks of childhood to the whist table of the adult. I propose this evening to consider a most diverting and exceedingly profitable amusement for medical men-namely, Urinary Analysis. The financial cost for this diversion is not great, the opportunity is abundant and the interest is without limit.

Almost every physician has one corner of his office which he can readily dedicate to this purpose-that of the wash-stand. Let him hang on the wall a small cupboard to hold his chemical re-agents, then fasten up a test tube rack, and he has a cozy corner to spend many happy, often thrillingly interesting, and always profitable hours of his spare time. Later, if he wishes to pursue the subject further, he must have a firm table with a microscope and then he is armed cap-a-pie to engage in one of the most important branches of his medical studies. What urine am I to examine? Kidney lesions are so comparatively rare," you say, "that it is only occasionally a well marked case of Bright's, and still less often a dia

* Read before The Saturday Night Club of Microscopists of Philadelphia.

betes occurs in one's practice." Granting this, for the moment, to

be true, you

First, want to be prepared to recognize any renal case when it does come to you, and

Second, such cases come very much oftener, in their incipiency, than you imagine. And it is just then, in their incipiency, that you want to meet them while there is yet ample time to whistle "down breaks," and check the onward course of the often already rapidly progressing disease. Make it your rule to examine the urine of every patient that comes to you, and you will be astonished to find a fairly large number of unsuspected albuminurias and occasional glycosurias. And it must not be forgotten that many other diseases besides Bright's and diabetes present most important symptoms and complications which are discoverable only by Urinalysis. The outlay required for this work need not be extensive a very few chemicals and test tubes suffice to keep track of the amount of the chlorides in pneumonia, of the albumen in scarlet or typhoid fever, diphtheria, nephritis and pregnant women or the sugar in diabetes. Beside the chemical re-agents and test tubes, a physician should possess a urinometer to note the specific gravity; an albuminometer to see whether the albumen in a given case is increasing or decreasing; a ureometer to gauge the urea; a saccharometer for the quantitative sugar test and a note book in which he should jot down the date and result of every examination. (Three or four dollars will cover the cost of the above instruments.) Urinalysis is such simple work, and it takes so little time that it is a wonder to me that every physician does not make as much a practice of it, as he does of prescribing the similimum, in every case. Almost every doctor, when a new case comes to him, thumps the chest, listens to the heart, counts the pulse, looks at the tongue, asks a few general questions about the appetite, state of the bowels, character of the sleep and then prescribes a remedy and perhaps directs a special diet. All this is quite right, but-how about those kidneys? How far have you taken them into consideration? And how can you prescribe a diet unless you know of a certainty that there is no albumen or sugar in the urine to guard against.

And not by any means are albumen and sugar the only foreign elements that one need look for. There is something of equal, if not greater importance and that is to look for and, when found, to prescribe a diet for excess of uric acid. Speaking of uric acid diathesis, here is an interesting diagnostic mark, and one that is but little known. We have all seen that delicate film or pellicle, show

ing a faint play of prismatic colors, which covers the top of urine This is often among the first indications of a

after it has cooled.

uric acid diathesis.

Let us right here remember that there is no need of being a specialist to examine urine. All doctors are not specialists in scarlet fever, typhoid fever, phthisis, diarrhoea, or mumps; and yet we all know enough to recognize them when we cross their path, and to treat them successfully. Just the same amount of general knowledge of urinalysis will help a physician amazingly to treat his patients. successfully, and will often save him from committing a bad blunder in diagnosis.

Do not think I would presume to attempt to instruct any of you who are here to-night. You all know as much of the subject as I do, and many of you know a great deal more! All I desire is to bring to your notice a few points in the analysis of urine which my experience has led me to emphasize. As I have already stated, make it a rule to examine the urine of all your patients. We should be as intimately acquainted with the urine of each of our patients as we are with the state of his heart, lungs, bowels, etc. In fact, between the choice of a knowledge of a patient's heart or kidneys, I should choose the latter. It is well to remember that when patients are confined to bed for the rest cure, or an accident, etc., the amount of urine they secrete is apt to materially lessen, and you need not expect them to pass "three pints" daily.

Always keep your apparatus for urinalysis perfectly clean. Remember this: To find albumen you must have an acid urine and clear urine. If the urine to be examined is not acid, render it so by adding a little acetic or nitric acid. In regard to clear urineyou cannot always make it transparent by filtering. I have met urines I could not clear up, even though I filtered through two or three papers at a time. In such cases add to the urine about a fourth part of its volume of liquor potassæ, warm, and filter. If this does not quite clear it, add one or two drops of the magnesian fluid, warm again, and filter. The fluid is then always clear and transparent.

To preserve urine from spoiling by being kept, or when it is to be sent from a distance, order about ten grains of salicylic acid to be added. Sometimes we receive urine which is fresh, but we are unable to examine it at once. Then add salicylic acid. Dr. Judson Daland states: "Three drops of chloroform to the ounce, is the method of preserving urine that I have employed for some years with great satisfaction."

Pus is not infrequently found in urine. Always in cases where