the cancerous masses, and to their mechanical effects on the neighboring parts, but chiefly to the general effect of the disease in lowering and extinguishing the powers of life.

The practical object of making this statement is to point out that the operation performed was in itself perfectly successful; it at once and perfectly evacuated the canal, and restored the patient from imminent death; it produced no local ill effect; it answered its purpose for eighteen months, and might, as far as appears, have continued to do so to any period to which life might have been prolonged. The development of malignant disease, however, prematurely closed the scene.

ART. 58.-Guarana in Chronic Diarrhoea. By Dr. HERVE, of Lavour. (Bull. Gen. de Thér., May 15, 1857; and British and Foreign Medico-Chir. Review, Jan., 1858.)

Dr. Hervé, of Lavour, calls the attention of the profession to the employment of a substance which is in common use in South America, and particularly in Brazil, where cases of diarrhoea and dysentery present themselves in a very severe form. Those who inhabit that country know that every family has a little provision of guarana, and that as soon as any one is seized with diarrhoea or dysentery, a little of the substance is scraped and infused in a cup of boiling water, which is swallowed at once with or without sugar. Dr. Hervé, following the advice of Dr. Mialhe, has given it in infusion, in sugared milk, and it is then much more agreeable, and does not lose its special characters. For the last five or six years he has employed this medicine daily; it has never failed him in the most obstinate cases of idiopathic diarrhoea, and almost always it has ameliorated the condition of the patient even in the most serious symptomatic cases. The guarana or paullinia has been also employed in the treatment of headaches; and it has succeeded in some cases connected with gastric derangement, but it has failed in others.

The guarana, as a medicine, was first described by Cadet de Gassicourt, in 1817, from a fragment which had been brought to him from Brazil by an officer attached to the French embassy. On this specimen a ticket was fixed, importing that this substance was much employed in Brazil for cases of diarrhoea and dysentery. Towards the close of the year 1822, an inhabitant of the same country, M. Gomès, sent to Mérat a complete specimen; it was a mass presenting the form, color, and volume of a sausage; there was joined to it a very rough bone, intended to act as a rasp, and which is always sold with the medicine. The learned botanist, Martius, afterwards occupied himself in discovering the plant which yielded the guarana, and he classed the climbing shrub which furnishes the guarana seeds among the Sapindaceæ, under the name of Paullinia sorbilis, in consequence of its employment as a drink. It may be used in the form of pastiles, syrup, pills, tincture and pommade, as well as in powder, and in combination with chocolate.

(E) CONCERNING THE GENITO-URINARY SYSTEM.

ART. 59.-On Albuminuria in Typhus and Typhoid Fever. By Dr. GEORGE JOHNSON, Physician to King's College Hospital.

(Medical Times and Gazette, Jan. 16, 1858.)

"It not unfrequently happens," says Dr. Johnson, in a recent clinical lecture on diseases of the kidneys, "that during the progress of typhus and typhoid fever, the urine contains one or more of the constituents of blood. The secretion may be simply albuminous in a greater or less degree, or it may contain a notable quantity of blood. A deep blood tinge of the urine is not likely to escape notice, but the urine may be very scanty and very albuminous, without any striking change of color; and in such cases, if your attention has not been particularly directed to this circumstance in the natural history of fever, a very serious complication may be entirely overlooked, and therefore left without remedy. I shall probably have repeated opportunities of pointing out to you

the complication of typhus and typhoid fever with renal congestion, a scanty secretion of albuminous urine, and the early occurrence of drowsiness passing into deep coma. In the mean time, bear in mind this practical advice. During the progress of typhus or typhoid fever, make it a point to examine the urine either daily or every other day, and test it for albumen. This can be done with so slight an expenditure of time and labor that the neglect of it is inexcusable. If you find that the urine is becoming albuminous and at the same time scanty, be sure that serious head symptoms will speedily appear, and give your prognosis accordingly, remembering that, cæteris paribus, the danger is great in proportion to the scantiness of the secretion of urine and the amount of albumen; greater, too, when this complication occurs at an early period of the febrile disease than when the malady is more advanced.

"With respect to the treatment of this acute renal disease occurring in connection with continued fever, I would simply remark now, that in every case repeated dry cupping in the loins is admissible and often very effectual. When the urine is very scanty, the albumen copious, and the drowsiness threatening, you may venture to abstract a few ounces of blood from the loins by the scarificator or by leeches, remembering that uræmic coma is more perilous than mere exhaustion, and that the relief of the renal congestion and an increased secretion of urine may be beneficially purchased at the expense of a few ounces of blood. Meanwhile the strength of the patient must be supported by liquid food and stimulants, according to the circumstances and symptoms of each case."

ART. 60.-On Diuresis occurring in Acute Renal Dropsy. By Dr. GEORGE JOHNSON, Physician to King's College Hospital.

(Medical Times and Gazette, Jan. 3, 1858.)

"What, then," asks Dr. Johnson, in a recent clinical lecture, "is the cause of this copious diuresis, which you will find to occur during the favorable progress of every case of acute renal dropsy? In this case the abundant flow of urine was obviously not the result of diuretic medicine, for none was given. It was, if I may so say, a natural and spontaneous diuresis; and the following is, I believe, the explanation of the phenomenon. During the acute and congestive stage of the renal disease, the constituents of the urine, both solids and liquids, accumulate in the blood, and are then effused into the areolar tissue and the serous cavities. Now, urea is a most powerful diuretic, as is shown by the abundant micturition which follows the injection of this substance into the veins of a dog. As soon, then, as in a case of acute dropsy the congestion of the kidney subsides, and the freedom of its circulation is restored, the retained urea begins to exert its natural diuretic influence; and the resulting copious secretion of urine speedily withdraws the accumulated ordinary solids and water from the blood; and then, by the quickened action of the absorbents, from the areolar tissue and serous cavities. In this way the dropsy is removed. "I am sure, from my own experience, that in the treatment of acute renal dropsy you gain nothing by giving diuretics. Bear in mind that a diuretic medicine, such as squills, or cantharides, or acetate of potash, acts by stimulating the kidney to an increased secretion, while the drug itself is being eliminated with the urine. If, then, you give such medicines during the early stage of acute renal dropsy, while the vessels of the kidney are gorged, and its circulation nearly stagnant, you impose upon that organ an extra amount of work, without in any degree increasing the eliminative powers of the gland; and if you attribute to the action of your medicine the diuresis which sooner or later follows its administration, you fall into the very common error of mistaking the natural course of a disease towards recovery for the curative operation of drugs."

ART. 61.-On a Method of ascertaining the Value of the several Reagents employed in discovering the Presence of Sugar in Urine. By M. BÉHIER. (Bull. Gén. de Thér., Aug. 30, 1857; Dublin Hospital Gazette, Dec. 1, 1857.) We recollect the eagerness with which the discovery of M. Barreswil's potash

copper liquor was received, which, applied to the examination of the urine, enabled us to recognize the presence of the smallest quantity of glucose. His method, though so easy of application, was still further simplified by promoting the reaction, by means of a little caustic potash. It was natural that analytical processes so ready should rapidly become popular. Their use, however, was not so certain as was believed, and a source of error seemed to endanger the prospects of this valuable acquisition.

M. Béhier, at a recent meeting of the Société Médicale des Hôpitaux, brought forward so many examples of the uncertainty of these reagents, that if chemistry had not directly furnished us with the means of counteracting this source of error, these analytical processes should have been rejected from ordinary practice. In fact, M. Béhier has shown that the urine of a very great number of individuals affected with various diseases is colored by potash, and even produces a precipitate with the potash-copper liquor.

The uncertainty of the reagent, in these cases, had been observed before, and M. Becquerel had pointed out its cause in his."Traité de Chimie pathologique." The following is, according to this writer, a mode of destroying the elements of the urine, which, as well as sugar, produce the coloration of the fluid, and of restoring to these reagents all their value:

"Take a given quantity of urine, one ounce; treat it with a given quantity of lead, say half a drachm; heat the mixture, when an abundant precipitate of a dirty-white color is immediately produced; filter the fluid, and treat it with sulphate of soda in excess. If, for example, we have used half a drachm of acetate of lead, we should add a drachm of sulphate of soda; heat the mixture again, sulphate of lead is thrown down; filter anew, and we obtain a clear, transparent fluid, containing sugar when it is present, urea, and some trifling salts. Urine so treated reduces potash-copper reagents, and assumes a brown color with potash, only when sugar is present. These two reagents are, therefore, in this manner rendered perfectly reliable.

"If the urine submitted to experiment contains albumen, the solid acetate of lead immediately coagulates this principle, at the same time that it carries down the other organic matters, and we are no longer embarrassed by it in looking for sugar.

"It hence results that whenever we wish to discover the presence of sugar in any urine, whether albuminous or not, we possess in the potash-copper liquer and in potash two excellent reagents; but on condition that we previously treat the urine with solid acetate of lead and sulphate of soda, the double reaction of which will remove all the acid or organic foreign matters which might reduce, decolorate, or turn green the potash-copper liquor, or produce a brown color."

ART. 62.-On Pertussal Glucosuria. By Dr. GIBB,

(Lancet, Jan. 30, 1858.)

In the year 1855 the fact was first pointed out by Dr. Gibb that the urine in almost every case of hooping-cough is saccharine, the quantity of sugar varying, generally but small, and sometimes a trace only being present. A considerable quantity he has, however, found on several occasions, the specific gravity being at the same time high, and in general characters the urine has been similar to that of diabetes. A case of pertussis, with urine in this last condition, was recently under Dr. Gibb's care, at the St. Pancras Royal Dispensary, in a child of six years, who had reached the spasmodic stage of the complaint, without any complication, unless the glucosuria be considered as such. The remarkable feature of this case was the rapidity with which the quantity of sugar diminished under the usual plan of treatment recommended by Dr. Gibb in this disease-namely, nitric acid in large doses. The specific gravity of the urine became lower and lower, the quantity of sugar diminished, and, as a cure was established within three weeks, not a trace of it was to be found. It is an interesting fact that nitric acid should so rapidly diminish the glucosuria. This may be effected in one of two ways: either by its curing the pertussis, and a condition with it which must hereafter be looked upon as symptomatic of it; or else the assimilation of the acid prevents the formation of the

sugar.

To the last view Dr. Gibb inclines, but he says large doses only will produce this, as experience has proved in his hands. This condition of the urine in hooping-cough is well worthy of record.

ART. 63.-On Sugar as an article of diet in Saccharine Diabetes. By (1) Dr. WILLIAM BUDD; (2) Dr. WILLIAMS; (3) Dr. BURD, of Swansea; (4) Dr. CORFE; and (5) Dr. BENCE JONES.

(British Med. Journal, Nov. 14, and Dec. 19, 1857; Jan. 2, Feb. 6, and March 13, 1858; and Medical Times and Gaz., May 1, 1858.)

I. There are probably few (says Dr. Budd), whose attention has been much directed to the subject of diabetes, who have not had misgivings, at one time or another, as to whether the common method of treating this disease by restricting the patient to a purely nitrogenous diet, or, to speak more correctly, to a diet from which sugar and its equivalents are excluded, really fulfils the true indications of the case.

Among the many circumstances that might be referred to as suggesting such misgivings, there comes :—

1. The strong and direct opposition in which this method very often stands to the natural cravings of the patient-cravings which, if not indulged, become, after a time, in many instances, so irresistible as to drive the subjects of them to fraud, in default of other means, in order to procure some portion of the proscribed articles.

It has even been laid down as essential to the success of this method, when conducted in hospital, that the patient should be kept in a room to himself, guarded by lock and key for that special purpose, so ineffectual have any less stringent measures been found to bar the diabetic man from the gratification of his desire for saccharine aliments.

The need of such precautions as these is in itself sufficient to raise serious doubts in the mind of any thoughtful practitioner as to the soundness of the principle on which they are founded. For although the appetites in disease are often perverted, and are rarely to be unreservedly trusted as guides to practice, yet they are often, as in health, exponents of true wants of the system. In some sense or other, they are very real elements of the case, whatever it may be, and not seldom are much more intimate interpreters of its great cardinal relations than any evidence we may be able to draw from more recondite sources. These suggestions may require to be modified by the results of experience, or may even be superseded by a higher knowledge; but in either case, we ought to be very sure of our facts before we venture to act upon them in contravention of strongly declared instincts. In diabetes, it would be difficult to show in either of these quarters sufficient warrant for the little heed which is paid to the natural desires of the patient in the all important matter of diet. We are certainly very far from having attained on the one hand, to a perfect theory of the disease, and our experience as to diet, on the other, is too onesided to enable us to found any certain conclusions upon it.

2. Another circumstance that tends very much to weaken faith in what may be called the orthodox plan of treatment, is that this plan is not only of little avail in most cases in long postponing the fatal event, but often signally fails in insuring for any length of time the specific object for which it is proposed -that, namely, of keeping down the quantity of sugar discharged with the

urine.

3. M. Bernard's important discovery, that the liver forms sugar as readily from nitrogenous as from amylaceous compounds, seems to take from this plan the plea of resting upon a scientific basis.

I am aware of all that may be said in reply to these observations, and I also know that they are open to cavil in various ways; but they sufficiently show, notwithstanding, as it appears to me, that the true principles on which the dietetic treatment of diabetes should be conducted are still open to consideration. We shall see how far this view is borne out by evidence of another kind, to be presently adduced.

Many of the points here touched on are illustrated in a very striking way in

a paper on Diabetes, communicated to the French Academy of Sciences by Professor Andral, rather more than two years ago, and published soon afterwards in the "Annales des Sciences Naturelles." After remarking that a purely animal diet not only fails, in a great number of cases, permanently to reduce the amount of sugar discharged by the kidney, but that this amount may even go on steadily increasing, in spite of the entire exclusion of saccharine and amylaceous compounds from the food, M. Andral relates the following case in point:

"One of the most remarkable, and at the same time one of the most conclusive, of facts of this kind, because of the absolute strictness with which the regimen was carried out, is that of a woman who, in the intimate persuasion that an exclusive animal diet could alone cure her, had the courage to subject herself to it during nearly two months, without deviating from it for a single day. During the whole of this time, she ate nothing but roast or boiled meat, and drank nothing but water, to which a little alcohol had been added. At the end of the two months, she was obliged to give up this regimen, which had become insupportable to her; and, besides, she was not better. At the moment of commencing this plan, her urine yielded 27 grammes of sugar to the pint. During the early trial of it, the proportion of sugar fell, by degrees, to 20, 15, 12, and at last to as low as 10 grammes to the pint; then suddenly, and without the remotest ground for supposing that any breach of rule had occurred, the proportion of sugar voided began again to rise. We now saw it progressively amount from 10 to 15, 20, 30, 44, 49 grammes to the pint; and there was, moreover, no single day in which this principle was altogether absent. Further, what is particularly worthy of remark, is that, when we first began to mix eggs, milk, a small quantity of bread, and vegetables with the meat, and to substitute wine and water for the alcohol and water, the sugar, contrary to all expectation, began to diminish anew, falling to 30, 26, and at length to 10 grammes to the pint. Then, again, after the lapse of some days, the regimen remaining unchanged, the sugar rose once more, until, at the end of three weeks from the first adoption of this mixed diet, the urine contained 54 grammes to the pint."

M. Andral adds, that this is far from being the only instance in which he has seen a large amount of sugar continue to be discharged in the urine in this disease, in spite of a purely animal diet; and he cites, among others, the extreme case of a diabetic patient, "who lived entirely on flesh, and whose urine contained, notwithstanding, the enormous quantity of 82 grammes of sugar to the pint; and as this man passed eight pints of urine every twenty-four hours, it follows that he expelled from his system, and consequently produced in the same period of time, as much as 656 grammes (or more than 20 ounces) of

sugar.

In the case of which it is the principal purpose of this paper to give some account, the same general fact was observed. The amount of sugar voided went on largely and steadily increasing, in spite of the rigid observance of a diet from which sugar and amylaceous compounds were excluded. But this case exhibited, in addition, the much more remarkable spectacle of a considerable and permanent reduction in this amount occurring concurrently with the recovery of the patient from a state of wasting and extreme weakness to one of good condition and comparative health, on substituting for this diet a scheme which not only included a large proportion of vegetable food, but more than half a pound daily of sugar in substance.

CASE. The subject of this case, Joseph Snailum by name, an agricultural laborer, 18 years old, was admitted on March 19th, 1857, into Ward 6 of the Bristol Royal Infirmary, where he still remains under observation. At that time, he had already been fifteen months ill. As in most cases of the kind, his malady had stolen insensibly upon him. Frequent calls to make water, by night and day; an unnatural thirst, together with loss of flesh and gradually increasing weakness, were the first circumstances that excited his attention. He had been unable to work almost from the beginning. Meanwhile, these complaints had gone on gradually increasing. For some time before he fell ill, he had been working in wet and marshy ground; but, apart from this, he

PART XXVII.

7