1040, and did not show a trace of sugar. Under the influence of the alkaline treatment, not only did the sugar not reappear in the urine, but the vision improved, and within two days became perfect. In four or five days the bowels ceased to be constipated, and some diarrhoea and bilious vomitings ensued, which recurred for a few hours; in each following day there was a marked improvement, the thirst became appeased, the urine less copious, the strength and virile power were restored, and after this time the patient was re-established in health, nor did the urine on several examinations give any trace of sugar. He was able to support all kinds of fatigue, and did not restrict himself to diet, but partook equally of animal and vegetable substances, avoiding only all acid drinks. M. Mialhe considers that in this patient the exciting cause was the excess of these acid drinks, and thinks that when it so happens the disease is more easy of cure than when it arises from suppressed perspiration.

The above case was published in 1849; but although many years had elapsed between that date and the publication of the work under consideration, no more recent case is announced, although the plan of treatment proposed is said to have furnished practical results of a most satisfactory character. Such is the theory of M. Mialhe as to the pathology of diabetes, and such the method he proposes for its alleviation or cure. Did the disease depend on the causes he assigns, the treatment would be most simple, and at the same time most complete; we know, however, that diabetes is one of the most intractable of maladies, and that the cures are very rare indeed; and this has been the case, not only before, but since the alkaline treatment has been made known and practised. This fact alone would argue that there is much that is faulty in the hypothesis. Let us now examine a little into the proposed explanation of the nature of glucosuria. We need hardly discuss the subject of the changes which amylaceous matters undergo in the alimentary canal-changes necessary in order that absorption may take place. It is, we believe, generally allowed that starch is changed into dextrine and glucose by the action of the saliva, but more especially the pancreatic fluid, and that it enters the portal vessels in the condition of the latter principle, starch-sugar; whether, however, it passes the liver as such, seems, from the experiments of M. Bernard, somewhat problematical. It appears, also, to be established beyond doubt, that the liver is a great sugar-forming organ, and that a very large amount is prepared by this viscus even when the food is entirely destitute of amylaceous principles, a quantity sufficient to supply the demands of the respiratory process. To this fact, however, M. Mialhe seems to shut his eyes, almost ignoring the truths elicited by M. Bernard, which certainly are among the most completely established of any that can be found in the domains of physiology. But M. Mialhe's theory does not depend on their admission, for it concerns more the destruction of sugar in the blood, whatever be the way it enter this fluid. The pathology of diabetes, however, is much involved in them, for the great question is this-Is there an abnormal formation of sugar in the system, or a loss of power of further decomposing this substance?

We have seen that M. Mialhe assumes that the non-destruction of the sugar is the real cause of its appearance in the urine: is this correct? And again-If so, is it due to a want of alkaline substances in the blood? M. Mialhe brings forward no evidence to prove that the sugar is not decomposed in the blood in diabetic subjects: he tacitly assumes such to be the case, and immediately endeavours to explain why it so happens. There seems, however, to be no proof capable of being brought forward in support of this opinion; as there is no alteration in the respiratory function, no difference in the gases evolved, no diminution of the temperature of the patient,—all of which we should expect were the saccharine matter not burnt off by the respiratory process. And again, other matters, artificially introduced into the blood of these subjects-as salicine, the neutral potash or soda salts, with vegetable acids, as the citrates and tartrates-are decomposed, and the products of the oxidation found in the urine. And lastly, all the phenomena of diabetes may be equally explained by supposing that there is an augmented supply of sugar to the blood, produced, as shown by Bernard, by an exalted glycogenic function of the liver.

Next, as to the explanation of the supposed deficiency of decomposing power in the blood for saccharine matter, we may remark, that M. Mialhe's stronghold is entirely without real support. For it seems questionable whether any neutral carbonates exist in the blood; and the bicarbonates of the alkalies do not possess the power of breaking up glucose; and no attempt has been made to show that the blood is less alkaline, or contains fewer carbonates, in diabetes than in health; and certainly, for the establishment of such an important point, it would not be difficult to procure a sufficiency of this fluid. And again, it is very questionable whether the explanation of M. Mialhe of the causes of the changes which sugar undergoes, is correct. That they take place is undoubted; but the reason may be very different from that assigned by our author. If the theory of M. Mialhe be right, we should be able to produce glucosuria at will, simply by the administration of a sufficiency of acids. This, however, has not been shown to be the case. Again, as we approach the subject of the treatment of diabetes, we discover that the hypothesis is most faulty; for in very many cases to which alkalies have been administered in large quantities, more than sufficient to neutralize any abnormal acid present in the blood, not even a diminution of the sugar has been discovered; and the result of the alkaline treatment has not been such as to justify the conclusions arrived at. The case of M. Garofolini seems to have been an exceptional one; and we know that now and then the disease assumes a form which almost entitles it to be called intermittent diabetes; and this often occurs without any discoverable cause. Sometimes, however, the sugar suddenly disappears, from the supervention of some other affection. From these and many other considerations which we might adduce, we should be disposed to consider the above hypothesis of the proximate cause of diabetes erroneous, until further and much more convincing evidence be brought forward in its favour.

The remaining portion of this chapter, which is devoted to the digestion of albuminoid and oleaginous substances, presents no facts

of sufficient novelty or interest to make it necessary that we pause to dwell upon them, more especially as we have devoted so much space to the discussion of the amylaceous principles.

The second chapter of the book is devoted to the subject of absorption, and to the consideration of medicinal agents which possess the property of rendering the blood either more plastic or more fluid; in this chapter, however, there is nothing which we can select with any advantage. Chapter III. contains researches upon the action of many important medicines, and the same order and plan is followed as in the work published by our author, and to which we before alluded at the commencement of our article-viz., the Traité de l'Art de Formuler; however, many facts are added, some of them possessing interest. Under the head of iodide of potassium, it is stated that iodine should never be prescribed in a free state, but as an alkaline iodide, and especially as iodide of potassium; and this latter salt should be neutral, and quite free from iodate of potassa. It appears from the researches of M. Leroy of Brussels, that specimens of iodide of potassium which have given rise to much gastric pain and irritation, contained a very notable proportion of iodate of potassa, of which it was very easy to be assured by adding a little concentrated acetic acid to the solution of the salt, which has the power of liberating the iodine from any iodate of potassa, and thus colour the liquid. M. Mialhe states that such impure iodide of potassium is frequently to be met with at the druggists' in France, and that many physicians in that country have seen the symptoms above enumerated produced by it. This last phenomenon he explains by supposing a portion of iodine to be set free by the action of the acids of the gastric fluid.

In this country such iodide has frequently been found in the market, and it arises from the method occasionally employed for its manufacture when iodine, for example, and caustic potash are brought together, the iodine dissolves, and two salts are formed from the changes which ensue, six equivalents of iodine and six of caustic potash giving rise to five equivalents of iodide of potassium and one equivalent of iodate of potassa; the two salts crystallize together, and by the action of a high temperature the iodate of potassa is resolved into oxygen and iodide of potassium, and thus six equivalents of the latter salt result; if, however, the last part of the process is not perfectly performed, a portion of the iodate remains undecomposed, and contaminates the salt. When, however, the process prescribed in the Pharmacopoeia of 1836 is made use of, which is effected by the decomposition of the iodide of iron, there is no fear of any such impurity being present. In the present London Pharmacopoeia, although no process for the preparation of the salt is given, yet a test is indicated which has for its end the discovery of any iodate, should it be present. Thus it is stated that when to a solution of the salt, starch and tartaric acid are added, no blue colour should be developed. Tartaric acid has no power of decomposing iodide of potassium and liberating iodine; but if the slightest trace of iodate of potassa be present the iodic acid is set free, which immediately gives rise to the production

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of the intense blue colour by the formation of the iodide of amyliu. Iodide of potassium containing iodate, colours the ointment yellow, and often itself becomes discoloured from free iodine being evolved. As yet we have not noticed the physiological symptoms described by MM. Leroy and Mialhe; whether their explanation is correct might easily be tested by administering small doses of the iodate itself, and comparing the effects with those induced by corresponding doses of free iodine; perhaps iodic acid itself would prove very irritating.

A very considerable space, more than sixty pages, is devoted to the consideration of the preparations of iron; and the investigations of M. Bouchardat, M. Quevenne, and others, as well as those of the authors, are detailed; to attempt to illustrate these at all fully would occupy a space far exceeding our prescribed limits, and we shall therefore confine ourselves to giving the conclusions which are arrived at:

1st. All the preparations of iron, which are either themselves soluble, or capable of becoming so under the influence of the acids of the gastric juice, and which are able to be decomposed by the alkaline substances contained in the blood, can be advantageously employed in the treatment of those affections which call for the use of iron.

2nd. All the preparations of iron, either soluble or capable of becoming so under the influence of the acids of the gastric juice, but which are not able to be decomposed by the alkaline substances contained in the blood, cannot be advantageously employed in the like affections of the system.

3rd. Preparations of iron having the peroxide for their base, as well as those containing the protoxide, can be successfully employed in increasing the amount of blood-globules in anæmic conditions of the habit.

4th. The oxides of iron, which produce the physiological effects of the metal, have no need to be united either to carbonic acid or any organic acid, in order to become assimilable.

5th. The preparations of iron with either the peroxide or protoxide for base have the same final efficacy, but the latter, if little soluble, require to be administered for a much longer time; the chemical reason for this is evident.

6th. The insoluble iron preparations constitute a class of medicines having a real therapeutic value, although slow in action, possessing no activity except from the acids contained in the gastric fluids; and as this acidity is limited in quantity and variable in different patients, the therapeutic activity of these drugs must be so likewise, and depend much upon individual peculiarity.

7th. The insoluble preparations do not produce their maximum intensity of therapeutic effect unless administered in divided doses.

8th. That among the insoluble ferruginous preparations of iron employed in medicine, the metal itself in a highly divided state, and the proto-carbonate, hold the first rank for activity; then the magnetic oxide; afterwards, among the least valuable, the red oxide of iron and Prussian blue.

9th. The soluble iron preparations are in general more active than those which are insoluble.

10th. All the soluble preparations of iron are not equally efficacious, many of them, from the acids with which they are combined, acting as astringents or styptics; as it is necessary to dilute these with a large quantity of water, their absorption is always imperfect-a circumstance which has induced some authors, especially M. Bouchardat, to erroneously look upon them as ineffectual in curing anæmia.

11th. The soluble salts of iron being capable of absorption without the aid of acids in the alimentary canal, those having the peroxide for their base, have (contrary to what occurs with the corresponding insoluble compounds) as much or even more activity than the ferruginous preparations which are capable of being decomposed by the alkalies of the blood. It suffices to cast a glance upon their per-centage composition, to know at once which is the most active. Being equally capable of absorption, that which contains most iron is the most powerful; the action of the ferruginous salt depending entirely on the contained iron, and not on the acid or other base which may be present.

12th. Among the soluble preparations of iron, those which at the same time possess least taste, are most rich in iron, and most completely absorbable, should be preferred; and no preparation of iron in these respects can be put on the same level with the tartrate of potash and the peroxide of iron-the ferri potassio-tartras of our Pharmacopoeia. 13th. The above salt, associated with the iodide of potassium, constitutes an ioduretted medicine more rational than any containing the iodide of iron, and able to be substituted with the greatest advantage in the treatment of those affections which call for the united employment of iodine and iron.

Such are the conclusions (by no means novel) arrived at by M. Mialhe, and in the main we should be disposed to agree with him. Having paid considerable attention to the subject, and clinically investigated the action of the ferruginous preparations, we feel somewhat confident in giving expression to our opinion upon this point. We are perfectly sure of the correctness of the first conclusion, that all preparations of iron, with the exception of the few indicated in the second proposition, are effectual for the cure of anæmia. We have tried every variety-iron itself, the protoxide and proto-salts, the peroxide and per-salts, together with the numerous ferruginous compounds in which the exact condition of the iron is somewhat doubtful (we allude to the citrates, tartrates, &c., containing some other base)-and we have invariably found that by their use the blood-corpuscles, if deficient, are augmented in amount; although we are equally persuaded that some preparations are more powerful than others, or will produce the effects in a shorter time. The preparations which contain iron, but which probably produce no effect on the system from the presence of this metal, are the ferro-cya nide of potassium, the sulpho-cyanide of potassium and of iron. These are not decomposed in the blood, but rapidly pass through the kidneys, and hence cannot aid in the formation of the blood-globule. The third and fourth conclusions are specially dwelt upon, M. Bouchardat having