ficiency, which accounted for the enlarged left are common, we are justified in believing that this

ventricle. condition is not so rare as so far supposed.

The enlarged right ventricle was referred to a mitral 1 Stokes: Diseases of the Heart and Aorta, Case xx.
2 Kolisko: Zeitschrift d. K. K. Gesell. d. Aerzte zu Wien, 1859, xv.
lesion, either double or single. Relying mainly upon 3 Bristowe: Trans. Path. Soc. London.
4 Coupland: Trans. Path. Soc. London, 1875, 26.
the presystolic thrill at the apex, the lesion was thought 5 Litten: Charit\l=e'\Annalen, 1878, ii, 182.
to be a combined mitral insufficiency and stenosis. 6 Chauffard: Rev. gen. d. clin. et d.
Therap., 1895, 2, 821.
7 Gouget: Rev. d. med., 1895, xv, 768.
Had there been only the presystolic murmur at the 8 Pawinski: Arch. klin. Med., 1894, 52.
9 Grawitz: Zeitschrift klin. Med, 1893, 23.
apex, it would have been interpreted as the presystolic 10 Bari\l=e'\:Arch. gen. d. med., 1891, 27 and 28.
murmur described by Flint in cases of aortic insuffi- 11 Gourand: Paris Thesis, 1865.
12 Gerhardt:
Congr. Intern. Med., xi.
ciency. I have since learned that Schwalbe has found 1314 Schwalbe:
Gerhardt: Charit\l=e'\Annalen, 1892, 17, 255.
a presystolic thrill at the apex in a number of cases of umes xliv and xlv.Virchow's Arch., 1890,119: Deut. Arch. klin. Med., Vol-
Vol-

aortic insufficiency without any accompanying mitral

stenosis. ON THE PRODUCTION OF HYDROCHLORIC
We had yet to account for the second diastolic mur- ACID IN THE GLANDS OF THE
mur at the base, transmitted down the sternum, and
for the absence of the second pulmonary tone, which, STOMACH.
if there was a mitral lesion, should have been accentu- BY J. A. WESENER, PH.C., M.D.
ated. Both of these could be easily explained by the CHICAGO. ILL.

supposition of a pulmonary insufficiency. This sup- PRELIMINARY COMMUNICATION.

position was strengthened and confirmed when, after In Medicine of November, 1895, I showed that
a few days' treatment, this murmur disappeared and hydrochloric acid is secreted by the mucous mem-
the second pulmonary tone reappeared. The improve- brane of the stomach and not formed by chemic action
ment was but temporary and the pulmonary tone was on the food products or fermentation. In these
again replaced by a murmur. experiments I found a nearly constant relationship in
The clinical diagnosis was aortic insufficiency, mitral the percentage of acid produced after each stimula-
stenosis and insufficiency, relative pulmonary insuffi- tion. Since then I have performed the same experi-
ciency, parenchymatous nephritis, hydrothorax and ments upon three cases of chronic gastritis. In these
passive congestion of liver. cases free hydrochloric acid could never be detected
After being in the ward a few weeks the patient with Boa's reagent, but upon quantitative determina-
died, and an autopsy was held four days after death. tion of total chlorin before and after evaporation of
The heart unopened weighed 1040 grams. Walls stomach contents a difference of chlorin was found
of both ventricles thickened, left ventricle 2 centime- which gave about the same per cent, of volatile
ters, right ventricle 1 centimeter. Aortic semilunars chlorid as was found in the cases of normal stomach,
thickened, not more than two-thirds the normal size where free hydrochloric was always present.
and incompetent to the water test. Pulmonary valves This decomposition of chlorid was not syntonin, as
unchanged in structure, but are incompetent to the the experiments were performed upon empty stom-
water test. Mitral valves thickened at the base, many achs. This led me to believe that I was dealing with
vegetations. Orifice admits six fingers. Myocardium a very unstable organic chlorid, which when evapo-
soft and friable, with scar in the interventricular sep- rated to dryness volatilized the same as free hydro-
tum. Tricuspid negative. Aorta shows atheromatous chloric acid, but would not give Boa's test. On the
plaques. Liver of passive congestion. Kidney of strength of this observation I performed the following
parenchymatous nephritis. experiment:
Postmortem diagnosis: Hypertrophy and dilata- 1. Pure nucleinic acid was obtained from three
tion of the heart; aortic, pulmonary and mitral insuf- dozen thymus glands of sheep.
ficiency, fatty and congested liver, parenchymatous 2. A syntonin solution was prepared; this con-
nephritis. tained .2 per cent, of egg albumin and .1 per cent, of
The autopsy showed first that there was no mitral hydrochloric acid; the acid was all taken up by the
stenosis, so that our inference of mitral stenosis from albumin.
the presence of the presystolic thrill at the apex was Then before proceeding, the nucleinic acid solution
not warranted. and syntonin were tested for free hydrochloric acid
It is much to be regretted that the pulmonary ori- with Boa's reagent, to be absolutely certain that it was
fice was not measured. The normal, according to absent. To 5 c.c. of syntonin a saturated aqueous
Rauhing, being 67 millimeters in the male, measured solution of nucleinic acid was added as long as a pre-
in fifteen cases, and 63 millimeters in the female, cipitate was formed. (The precipitate is a nuclein
measured in sixteen cases. Peacock's figures vary proteid.) This precipitate was filtered out and the
from these, being 90 mm. in the male, measured in filtrate tested for free hydrochloric acid. Boa's reagent
sixteen cases, and 88 mm. in the female, measured in gave a positive reaction. The experiment was re-
thirteen cases. peated several times, the results always the same.
The water test as applied to the pulmonary valves On making a. quantitative estimation of the chlorin,
is much more reliable than when applied to the aortic in the syntonin and after precipitation with nucleinic
valves, for there are no coronary arteries through acid, it was found that all the combined chlorin had
which the water may escape, and the difference been discharged as free hydrochloric acid.
between the blood pressure under which the valves About this time I had the good fortune of seeing a
close during life and the pressure of the water test is case at the laboratory which I must report as it will
not so great as with the aortic valves. be the keynote of my theory, which I will state in the
From this case and the others so far reported, we conclusion. The patient was a man who has suffered
must conclude that relative insufficiency of the pul- from chronic gastritis for several years. The first
monary semilunar valves is possible, and inasmuch examination of the stomach contents gave the follow-
as the primary diseases which may cause this lesion
ing: Reaction alkalin, free hydrochloric acid absent,

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 mucus abundant. He was given hydrochloric acid; cases, enters the system through an abrasion on the
three weeks later another examination was made. hands, usually caused by a puncture made by the fins
Reaction slightly alkalin, Boa's and Gunzburg's of the fish.
reagent gave a reaction for hydrochloric acid. The The symptoms vary in degree according to the
red color which was produced was not as sharply amount of poison entering the system.
defined as when free hydrochloric acid is present, but In some cases there is only a slight swelling and
more of a diffuse red; furthermore, the reaction did redness at point of injury, or a small nodule forms
not take place until the last drop was evaporated, which is annoying for a few days. In other cases
whereas when the acid is present in a free condition, painful abscesses form which are slow in healing, the
the color shows very soon after the heating is com- patient, however, being able to go about but unable
menced. A quantitative determination of chlorin to follow his vocation.
before and after evaporating the stomach contents, In the severest type of cases met with there is after
showed that a loss of chlorin always took place. From two or three days of general languor, a well-marked
these facts I feel justified in saying that hydrochloric chill followed by fever and sweating. The point of
acid is never present in a free state in the glands of injury becomes swollen, red and very sore and develops
the stomach but always in combination with a proteid, into a deep-seated abscess, the pain from which is
and when this body is thrown off from the glands a excruciating and agonizing in the extreme. The
decomposition takes place, giving free hydrochloric chill or a chilly sensation recurs daily and fever
acid and a proteid. becomes continuous, accompanied by vomiting and
The reason I have for this statement is: great muscular weakness, sometimes attended by deli-
1. In the cases of chronic gastritis that I have rium. The tongue becomes heavily coated and the
examined, there is a very unstable proteid chlorid skin usually sallow.
(which is not syntonin), which when tested for free These symptoms continue with greater or less
hydrochloric acid is negative, but when estimated severity until the formation of pus, which occurs in
quantitatively acts just like free hydrochloric acid. from four to eight days, when they ameliorate, leaving
2. I have shown what a powerful affinity nucleinic the patient exhausted and often anemic. Secondary
acid has for albumin and that when chlorin is in com- abscesses often form in the axilla, and congestion of
bination it is discharged as free hydrochloric acid. lungs a not unusual and dangerous complication.
3. In the one case of chronic gastritis a reaction The prognosis is favorable as the disease is seldom
was had for free hydrochloric acid, although the reac- seen except in fishermen, who are of
necessity a hardy
tion of the fluid was alkalin to litmus, phenolphthalein and robust set of men, but would in more delicate
and lacmoid. The acid could not have been there in persons undoubtedly show a small percentage of
the free state but must have been there in a proteid deaths.
combination, which when heated very gently decom- The treatment consists of removing the exciting
posed giving free hydrochloric acid. cause of the disease, relieving pain and keeping up
4. That the nucleus of the cells in the glands of the strength of the patient.
the stomach take up the chlorids from the blood and The prophylaxis, which can seldom be applied, con-
combines them with the pepsinogen and rennet zymo- sists in at once washing the abraded or injured surface
gen; this combination remains intact in the glands, with fresh water and an antiseptic solution.
but when discharged decomposes into free hydro- Purgatives at the beginning of the disease are a
chloric acid, pepsinogen and rennet zymogen. The necessity in most cases and calomel in small doses is
acid thus liberated first acts upon the albumins to usually indicated during its continuance.
form syntonin and then acts upon the zymogens and The strength of the patient must be kept up by
liberates them into an active state. I believe this quinin and iron and opiates freely administered.
assertion is correct for the reason that pepsin and ren- When suppuration is established tincture cinchona
net are very closely related to nucleinic acid. comp., aromatic sulphuric acid and stimulants are to
be freely given.
The abscesses which form must receive careful
FISH SLIME DISEASE.
Read before the Cape May County (N. J.) Medical Society.
attention, early and free incision made and the posi-
tion of the parts so arranged to favor the escape of
BY EUGENE WAY, M.D. the secretions.
PRESIDENT OF THE CAPE MAY COUNTY MEDICAL SOCIETY AND MEMBER
OF THE AMERICAN MEDICAL ASSOCIATION. Poultices must be freely used until the discharge
DENNISVILLE, N. J. of pus has nearly ceased, when carbolized cosmolin or
The title of my paper is the name applied by the an ointment composed of hg. cum creta two parts,
laity to a disease, which, owing to the location of our cosmolin eight parts, should be applied.
county and the occupation of a large number of its Perfect cleanliness must be insisted upon and dis-
inhabitants, is frequently met with by the members infectants such as acetanilid, creolin, carbolic acid or
of this Society, and undoubtedly by all physicians corrosive sublimate, unsparingly used throughout the
living near the seashore, but of which little or nothing disease.
has been written or published in our text-books. Medical
The disease consists essentially of septicemic in- died from Caprice.
A prominent physician of India recently
the bite inflicted by one of the deadliest of snakes ;
—

flammation due to the entrance into the blood through he had been making experiments with a view to the discovery
the lymphatic system of the slimy exudation covering of an antidote, and supposed he had rendered himself proof
the fish of our bays and ocean. against the venom of snakes. One of the worst victims of
rheumatism we ever knew was a man who had discovered a
The class of persons most liable to this disease are positive cure for that disease. The secretary of a notorious
the hardy fishermen who follow the sea for a livlihood, Cincinnati consumption-cure company died of tuberculosis.
and so well is the disease and its cause known to them The former proprietor of the Lydia Somebody's great female
nostrum is in her grave dead from the very diseases that her
that they have named it as above. successors are indecently advertising against in the poorer class
The poison causing this disease, in the majority of of daily papers.—Massachusetts Medical Journal.

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