On the Influence of Lime and Magnesia in Drinking-Water in the Production of Disease

J. C. Murray
1872 BMJ (Clinical Research Edition)  
Sept. 28, 1872.] THE BRITISH MEDICAL 7OURNAL. 349 minutes in the direction just described. By this application, the base of the brain, the spinal cord, and the cceliac plexus of nerves, are simultaneously brought under the influence of the current. 2. [ant of sleep is one of the chief complaints of patients sufferingr from rheumatic gout. This arises partly from want of exercise in the open air, anid partlv from the circumstance that the pain is apt to get worse at night. The patient keeps
more » ... patient keeps tossing about in bed from being unable to fin(d a really comfortable position. " Nature's sweet restorer" thus flees the pillow of the sufferer, who generally dreads the night as his worst time. Opium and morphia are rarely applicable in these cases, as they generally excite rather than soothe, and impair the action of the stomach and the liver still more. Hydrate of chloral often steps in as the right thing in the right place; but I believe you will agree -with me when I say that the more ample our experience of that remedy becomes, the more frequently do we find cases in which the system does not tolerate it, either in small or large doses. Where morphia and chloral fail to procure sleep, few other drugs will succeed in doing so; and it must, therefore, be looked upon as a considerable advantage connected with the use of the constant current, that under its influence sleep soon becomes prolonged and refreshing. No special application is necessary for attainincg this end, the one I have just mentioned being .iuite sufficient. Pa3. Fis is another invariable symptom of rheumatic gout, and one 'which frequently resists the administration of sedatives and counterirritants. Even subcutaneous injections of morphia and atropia have ,only a temporary effect, which rarely extends beyond twelve or twenty--four lhours. The pain is generally most severe in the deformed joints, but is likewise felt in many other parts of the body. For the allevia-'tion of the pain, the constant current is the most useful remedy with which I am acquainted. It must in this instance be applied to the suffering parts, so that the positive pole, armed with a small electrode, is made to touch the sore points; while the negative, connected with a large electrode, is placed in the neighbourhood. The current used may in this instance be somewhat more powerful than where it is employed for general tonic effects; and if a short application, say of one or two minlutes, be not successful, this may be extended to four or five minutes. The effect is, in many instances, almost magical. 'inasmuch as pain, which has been fixed in some particular spot for moniths and years, is, as it were, charmed away by one or two applications. 4. The defo/rit/ics which rheumatic gout produces, more especially in the interphalangeal joints of the hands and feet, resist the use of the current more obstinatelv than the other symptoms which have been mentioned; and it requires much patience and perseverance on the part of the practitioner and the patient to reduce them to any extent. Provided, however, that the galvanic treatment is followed up for a sufficient length of time, even extensive deformities may be inmproved, which is a matter of considerable importance, as most patients belong to the female sex. No one who has not seen it can have any idea of the beneficial effects which the current will produce in the long run on these deformities, even where thev are extensive, and where the patients are not verv old. It seems as if the action of the vasomotor nerves were gradually directed back into its proper channel. Unfortunately, many patients want to be cured in a week of a disease which is essentially chronic in its progress ; and some practitioners are inclined to discontinue a special treatment too soon, unless immediate effects are produced by it. In this as in many other complaints the ultimate success of a particular plan of therapeutics depends not alone on the remedies which are used, but also very materially upon the more or less systematic use made by the practitioner of his remedies ; and last, not least, upon the intelligent co-operation of the patient. In order to re-(luce deformities, galvanisation of the cervical sympathetic nerve must he bad recourse to. By what I have said I do not by any means wish to imply that the use of internal remedies should be altogether eschewed in the treatment of rheumatic gout. If we were, for some reason or another, to abstain completely from their use, we should only deprive ourselves of many chances to d-o good to our patients. Although in the system of therapeutics wlhich I have pursued for rheumatic gout, I have given the iirst place to the constant current, I have frequently prescribed medicinies which I thought would provelbeneficial for removing certain complications which were present. Thus wlhere there was an excess of aci(iity in the system, as evidenced by a highly acid condition of the nmuicouus membrane of the tongue, the perspiration, and the urine, I have given alkalies or bismuth; for constipation, I have ordered Marienhad or Frederickshall mineral water ; where the blood appeared to he verv much impoverished, the ferrum redactum of the IPharmacopceia, or Spa water, was prescribed. All these and some other remedies I hlave used were, however, only auxiliaries of the galvanic treatment, andl could not of themselves have exerted any decided influence upon the progress of the disease. In conclusion, let me imnpress upon you once more the necessity of persevering with the use of the galvanic current, if it is to be used at all. The circumstance that most of our patients will be above 45, and not a few above 6o years of age, in connection with the obstinate character of the malady itself, must prepar-e us for slow results, more especially as far as the improvement of the deformities is concerned. Pain, indeed, is often relieved at onice, but it is very apt to return: the patient often becomes rapidly stronger-, but at times the old debility will again be felt, more especially if hie undertake to do more, either in business or pleasure, than he is able to do; and a sleepless night may again occur after many good nights in succession. It is therefore necessary to tell the patient at once that a rapid cure is quite out of the question. The current should be used, either daily or three or four times a week, for at least a mointh or six weeks; anid if the patient continue to improve, we may go on witlh it much longer than that. If, however, after that time he does niot seem to make any further decided progress, it is better to discontinue the treatment for a month or longer, and then to recommence it. Those who will not shirk the sometimes rather tedious labour involved in carrying out such a treatment perseveringly, will ultimately be amply rewarded for their trouble by an amount of success which, in some formns of the disease, could not have been obtained by any other line of treatment. Newcastle-upon-Tyne. TIIE subject of my paper is of great importance to every one who, like ourselves, resides in a magnesian limestone district. It therefore well deserves to occupy a portion of our time, especially in this progressive age, when preventative medicine is engrossing so much attention. What I am about to advance is founded upon a few cases only; not, however, in consequence of a paucity of such cases, but rather the difficulty of fully testing the indicated plan of treatment, from inability hitherto of obtaining soft water in a town and region where every sample of drinking-water is saturated witlh lime and magnesia. Last March, I read, in Tuze Urtine and(i its Derangements, by Dr. George Ilarley, that "oxalate of lime and phosphatic calculi are the two most common forms of stone met with in districts where the water is impregnated with large quantities of lime ;" and that "the lime must be got rid of from the drinking-water; for, should it by any chance contain an excess of lime, its habitual employment will completely frustrate our best efforts at treatment." On perusing this, a previously dim and uncertain light became to me fixed and clear; not as yet, however, to attain the brilliancy of the lime or magnesian light, but perhaps sufficient by which to indicate other cases in which soft water, or water freed from lime and magnesia, would be of service in the prevention or cure of disease. On referring to older works on urinary pathology, I find that in I844 Dr. Golding Bird was the first to bring tinder notice the frequent presence of oxalate of lime in the urine of inhabitants of towns. In I849, Dr. James Begbie pointed out the connection between oxaluria and imperfect digestion with sequent mental despondency. In I850, Dr. Bence Jones said distilled water instead of spring water will lessen the quantity of lime passing through the body, and hence oxalate of lime in the urine. He also states that lime-water will cause phosphatic deposit. Sir Thomas Watson points out the risk from drinking water containing lime in oxaluria ; and Dr. Atkin recommends, when oxalates appear in the urine, to avoid water conitaining lime. Dr. Harley, in the second volume of the Mledlical Timoes anid Gazette for 1864, is, I believe, the first to show the imminent danger of lime in drinking-water in what was wonit to be termed the phosphatic diathesis. My experience in the action of solvent remedies in gravel and calculi has not been so satisfactory as I could have wished ; but, following the light shed by Dr. HIarley, and acting by it whenever practicable, I am enabled to support the doctor's statements. Onie patient, e g., with ammoniaco-magnesian phosphate and carbonate of lime sediment in his urine, has since been relieved by mineral acids and the use of soft water from Ilamburgh, lhe fortunately being a sailor. Two others, by the same treatment and distilled water, are now passing acid urine, the physical signs of renal calculi are less urgent,
doi:10.1136/bmj.2.613.349 fatcat:dygdfdej3za5nk57ginh5w62da