On stomach and nervous disorder, as connected with the oxalic diathesis / [James Begbie].

Begbie, James, 1798-1869

Date:: 1849

Catalogue details

Licence: Public Domain Mark

Credit: On stomach and nervous disorder, as connected with the oxalic diathesis / [James Begbie]. Source: Wellcome Collection.

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empiric, to the injury of themselves, and the disparagement of the profession. With the view of lessening these evils, and recommending a still more careful examination of the urine in dyspepsia, and thus avert¬ ing the many serious lesions which result from its continuance, I venture to submit the following histories to the consideration of the Society. I. A clergyman, aged 36, of sanguine temperament, and spare habit, studious and devoted to his profession, which he had exercised for many years in North America, applied to me at the close of October 1845, for the relief of symptoms of stomach affection, under which he had laboured for many years. He was highly dyspeptic and nervous, and in his adopted country had been treated actively for u bile’’ and “liver,” and had undergone, by different hands, a va¬ riety of prescriptions, from the mild anti-bilious pill to the large and salivating doses of mercury, with only one effect,—the aggravation of his sufferings. After long trial, and many disappointments, he was forced to relinquish his calling, and return to Scotland, in shattered health, and broken spirits. On his arrival, at the date referred to, he was pale and emaciated, and indications of mental and bodily suffering were discernible in his countenance and manner. His appetite was depraved, and he ate largely. He suffered from flatulent dis¬ tension, and irregular beating of the heart ; from langour and lowness of spirits ; from restless nights, and troubled dreams; from unrefreshing sleep, and anxious awakings. He was incapable of mental application, and had well- nigh abandoned the hope of restoration to his duties, and to health. His skin was dry and parched ; his tongue loaded ; his bowels irregular, and the de¬ jections unhealthy. His urine, which hitherto had not been examined, was of a deep amber colour,1 and perfectly transparent, possessing a peculiarly rich smell, and a sp. gr. of 1 028. It was of acid reaction, slightly phosphatic, and contained urea in excess. Under the microscope, which alone can determine satisfactorily the presence of the oxalate of lime, a large number of the charac¬ teristic crystals of that deposit were discovered, and the treatment pursued was in accordance with the principles and practice maintained by Dr Prout, in the management of that diathesis. The bowels were cleared by repeated doses of gentle laxatives; the diet was regulated so as to exclude, as much as possible, all saccharine materials,—and milk, farinaceous vegetables, and animal food in small quantity, enjoined. Tepid sponging and warm clothing were also recom¬ mended, and the nitro-muriatic acid in doses of twenty drops twice or thrice a- day, prescribed.2 On the 25th of November, nearly four weeks from the com¬ mencement of this mode of treatment, the urine was again examined and found of sp. gr. 1’024, while it maintained the former characters, both under the eye, in glass vessels, and under the microscope. The general appearance of the pa¬ tient, however, was somewhat improved, and the dyspeptic and nervous symp¬ toms were less distressing. A steady perseverance in the same mode of treat¬ ment was enjoined. On the 18th December, the urine was of a straw colour ; 1 For a correct account of the characters of the urine containing the oxalate of lime, see a paper by my son, Dr J. W. Begbie, in the “ Monthly Journal ” for March 1847. 2 1 have generally adhered to the following formula, omitting occasionally the syrup and increasing the water. B Acid. Nitric. Dil. - Muriatic. Dil. Syrup. Aurant a ^ss. Aqu?e ^iss. Misce. Sig.—A tea-spoonful, mixed in a wine-glassful of water, before meals.