Dr. Hassall's very valuable paper, in the 'Medico-Chirurgical Transactions,' on the Development of Torula in the Urine. When sugar is present in urine in smaller quantities than can be detected by the action of chemical re-agents, he has shown that the sporules of the sugar fungus, or even a higher stage of development, may be readily detected by the microscope.-Lancet, Jan. 21 and 28, pp. 66, 96.

68.-Diabetes treated by Alkalies.-Sir H. MARSH, Bt., says :Amongst the agents capable of controlling the saccharine diathesis may be enumerated the alkalies. Of these, that which I have found the most useful is a combination of lime water, ammonia, and soda, given about an hour after each meal. Years ago I met the late Dr. Colles in consultation. The case was a severe one of diabetes; I asked him what he would propose to give. He replied, lime water and hartshorn. I asked him on what principle he proposed the remedy? His answer was: 'I know nothing about the principle, but I know the fact, that it does more good than any other medicine.' And so it did in the case we consulted about. I state the answer in his own words because it was so characteristic of that eminent man whose departure from amongst us we have all had such reason to deplore. In the observation, memory, and application of facts he greatly excelled."-Dublin Quarterly Journal, Feb. 1854, p. 7.

69.-Treatment of Diabetes Mellitus by Rennet. By DR. H. FEARNSIDE, Physician to the Preston Dispensary.—[Dr. Gray, of Glasgow, mentions the use of rennet in this disease, and speaks from his experience of it in three cases very favourably. Dr. Fearnside was induced from these remarks to try it in the following case:]

Mrs H., a tall, spare woman, aged 55 years, had suffered from bad health for some time, without being able to indicate the existence of any special ailment. She had lost strength and flesh, and for some months before she fell under my notice, her debility had increased so much that it was with difficulty that she attended to her ordinary domestic duties. For a considerable time she had remarked that the quantity of urine passed was excessive, and she had been harassed by constant thirst. When I first saw her the expression of the countenance was haggard and anxious; the skin was hot and dry; the pulse quick; the tongue was loaded with a yellow fur; she complained of inodorous eructations, heartburn, and flatulence; the bowels were confined; the thirst inordinate. There was great muscular weakness, and severe pains in the back and limbs. The quantity of urine passed in twenty-four hours was five quarts; it was acid; specific gravity 1046, and gave evidence on the application of the potash and copper tests of containing sugar.

After the use of some gentle aperient medicine, the diluted mineral and hydrocyanic acids acids were prescribed, and with more or less regularity, were taken for some months. The diet was strictly limited to butcher-meat, fish, eggs, milk, and branbread. Fresh vegetables, as cabbages, were taken occasionally. Brandy and water was allowed as a beverage. A dose of rennet was taken after each meal.

A fortnight after the adoption of this plan, the patient became so conscious its good effects, that notwithstanding the vigorous exercise of self-denial which is required, no further exhortations from me were needed to ensure its steady employment. The digestion improved, the thirst subsided; the quantity of urine passed in twenty-four hours fell from five quarts to two quarts, and eventually to three pints, and its specific gravity descended in three months from 1046 to 1020. has now for some months been free from sugar, although the patient has cautiously and gradually returned to her ordinary mode of life. She has recovered in a considerable degree her strength, but remains spare and thin.—Monthly Journal of Med. Science, March 1854, p. 252.

70.-ON THE CHARACTERS OF URINE DEPOSITING OXALATE OF LIME.

By DR. DOUGLAS MACLAGAN, F.R..S.E, &c.

It

[After giving an elaborate table of thirty-four cases of this kind of urine, Dr. Maclagan observes:]

Dr.

The principal characters which have been noticed as belonging to urine containing oxalates, are the following:-(1). A density somewhat higher than natural, indicating an excessive elimination of urea, or of the indeterminate extractive matters of the urine. In the series of cases recorded by Dr. Golding Bird, one-half of the specimens ranged from 1015 to 1025. Some were as low as 1009; some as high as 1030. In the cases recorded by Dr. J. W. Begbie (Monthly Journal, March 1848), the average density was 1028; the extremes being from below 1015 to above 1030, and in one case 1040. Prout states, in general terms, that the urine in such cases is of moderate density. (2). A colour, according to Dr. Prout, pale citron yellow, or greenish; according to Golding Bird, amber, never greenish; according to Dr. Begbie, amber, darker than in health. An odour generally natural, rarely aromatic, like mignonette (Golding Bird); on the other hand, aromatic, occasionally approaching to that of the sweet-briar, noticed in urine containing the cystic oxide (J. W. Begbie). (4). A reaction almost always more or less acid, frequently powerfully so.

(3).

Very contradictory opinions have been expressed regarding the pathological importance of the oxalate of lime in the urine. On one hand, we are told of the "miseries which flow from the oxalic

diathesis,"that from it sometimes "the bodily suffering is considerable, and the mental excitement verges on insanity,"—that "it is so generally important in its pathological bearings that it merits special attention." On the other hand, it is as confidently affirmed, that "oxalate of lime scarcely indicates a more serious derangement of the bodily health than a deposit of urate of ammonia does,"—and that to "set up such a diathesis as the oxalic is unreasonable, and contrary to the spirit of rational medicine." As usual in cases of such discrepancy of opinion, the truth will probably be found to lie between the two extremes. It does appear to me that, pathologically speaking, too much has been made of the expression, oxalic diathesis. Invested as the subject is with all the interest of a zoo-chemical question, its designation of oxalic diathesis, leads, I suspect, though it does not directly express it, too much to fix attention upon the mere idea of an inveterate tendency on the part of the elements of the food, or the elements of the tissues, to undergo a certain abmormal chemical metamorphosis, and excludes too much from view what is the really important question, can we attain to any knowledge of the cause why such an abnormal chemical change should occur at all? The objection to the phrase oxalic diathesis appears to me to be, not that it involves an erroneous pathological theory, but that it is no theory at all. It is the mere expression of the fact, that, in a certain class of cases, oxalate of lime does occur in the urine in large quantity, and often for a considerable length of time: it gives no enlightenment as to the reasons why this should be the fact. The same is true of the expressions lithic and phosphatic diathesis. When we have got the length of designating certain cases by these names, and when we have by the usual process of chemical formulation shown how oxalic, uric, and phosphoric acid compounds can be formed in the body, we have not, I apprehend, made out their pathology. We have only cleared the ground so far as to reach the point of inquiry,-Why in three cases where the nutritive function is perverted, shall a series of actions be set up which shall lead in A, to the deposit of oxalate of lime; in B, of uric acid; and in C, of phosphatic salts from the urine? It is only when these questions are settled that we shall be able to say that we know what is really meant by the expressions oxalic, uric, or phosphatic diathesis.

I have been much struck in the perusal of the standard works and memoirs on this subject with the circumstance, that while it is generally stated that the exciting causes of the disease are easily traced, comparatively little attempt has been made to impress the reader with the importance of paying attention to these exciting causes; and yet I believe that an attention to them is of more importance than anything else, as a guide both towards proper discrimination and successful treatment of such cases. If there be anything more established than another regarding well-marked oxalic urine it is this, that it always is accompanied by a train of symp

toms which point very decidedly to something wrong in the nervous system. Langour, inaptitude for the performance of duty or enjoyment of recreation, fretfulness, and hypochondriasis, are among the phenomena which are presented. Now, it seems to me to be an essential point to come to some understanding, as to whether these precede or follow the formation of oxalic acid in the system, whether the are, in whole or in part, its effects or its cause? It is, perhaps, not easy to determine this. Patients often do not come under medical treatment until both these phenomena are in full activity, and the history of the case does not always enable us to form any plausible opinion on this point. But it will, I think, generally be found, that when good information is afforded us as to the previous history of the patient, his ailments can be traced to something which would tend to impair the energy of his nervous system, or something which entailed upon it too great tear and wear; and which in either case prevented it from duly performing its duty of regulating and controlling the organic functions. For example, the exhaustion of the system by recent acute disease, as pointed out by Dr. Walshe, or long-continued chronic disease of some other kind, especially if involving the organs of digestion; or direct injury or organic disease of the nervous centres may be the cause in one set of cases, whilst, in another set, either too sedulous an application to business, or mental distress and anxiety, or, perhaps, even the want of some healthy mental stimulus, may be the origin of this state of the nervous system. If this should prove to be true, then certainly there is no necessity for the assumption of a special diathesis, and that which we designate the oxalic diathesis would resolve itself into this, a state of the nervous system, under which the organic functions become unduly performed, and in which, among other morbid phenomena, physical and psychical, gradually becoming aggravated as the case proceeds, some of the elements of nutrition are mal-assimilated, and along with the effete matters of the tissues, pass out of the system in the form of oxalic acid, instead of being carried off in some more normal state of combination. This is essentially the doctrine of Lehmann, who, though undoubtedly speaking rather with the authority of a chemist than of a physician, appears to have taken the right view of the cause of the occurrence of the oxalate, in ascribing it to a want of proper agency in the nervous system. It has always appeared to me a more feasible doctrine, than to regard the oxalate as a poison in the blood generated by an unexplained diathesis, and producing all those morbid phenomena in the nervous system. But to admit this is quite a different thing from going so far as to maintain with him and some English authors, that there is no essential connection between the oxalates and the symptoms which accompany them; and that the formation of oxalate is

of little pathological importance. But it is needless to argue this question, as it appears to have been satisfactorily answered by Dr. Golding Bird.

I apprehend that if functional inefficiency in the nervous system be in any way recognised as a cause of the formation of the oxalates, it must be by its exerting an injurious effect on the respiratory function. By this is to be understood not any interference with the free ingress of air to the lungs, although this when it occurs, appears occasionally to lead to the formation of oxalates, as in chronic bronchitis, and pulmonary emphysema, but a disorder of the great respiratory function throughout the system, the oxygenation of the calorific elements of food and of effete matter of tissues. Now, the hypothesis which appears best to meet the case is, that from deficient innervation, the vital force and self-preservative power of the tissues is impaired; their waste goes on at an unnatural rate, and, perhaps, in an irregular manner; and that hence arise the increase of urea and extractive in the urine, and the emaciation and debility which characterise the disease when fully developed. But, as under these circumstances, the oxygen of the blood is used up in wasting the tissues, there is not enough of it adequately to consume the calorific elements of the food, and hence some of the carbon, especially that which is taken in the form of such respiratory elements as sugar, &c., which ought to have passed off into carbonic acid, is only oxidised so far as to form oxalic acid. It is not unworthy of recollection in relation to this view, that the over indulgence in sugar is one of the commonest causes of keeping up, and its avoidance one of the most important means of dimishing, the excretion of oxalic acid by the kidneys. Nor does this view infer the revival of the idea that there is any relation between oxaluria and diabetes, and that the one tends to pass into the other. There does not seem to be the least evidence of this. The greater part of the oxalic acid, therefore, is probably furnished by the mal-assimilated unazotized elements of the food, but there seems no reason to doubt that mal-assimilated nitrogenous matters likewise contribute towards its formation, because oxalates continue to be deposited in quantity from the urine when the use of unazotized food is very much restricted. In this case we may accept the doctrine of Bird, that the nitrogenized food is first converted into urea, or, as Liebig would have it, into uric acid, both of which are known, under decomposing agencies, readily to yield some oxalic acid along with other products.

I apprehend that the train of dyspeptic symptoms which occupy generally the most prominent place in the patient's complaints, are also to be ascribed to defective nervous agency. Dr. Prout long ago pointed out that the reducing function of the stomach is impaired in cases of this kind, and this may, I think, be interpreted as meaning that the muscular power of that organ is defective. The stomach symptoms, complained of by patients with oxalic urine, point more to this than to a vitiated state of the gastric secretions. Heartburn, the raw feeling of acid in the throat, pyrosis and fœtid breath, according to my observations, present themselves less frequently;