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We think the above instances suffice to show that Dr. Bakewell has not yet attained a position which justifies his offering himself as an instructor to the public ; and we would suggest for his consideration, that in order to become a successful popular writer, it is not enough to publish a mere réchauffé of scanty notes taken at school lectures.
ART. XIV.-Summary of New Publications. DURING the past three months we have received, in addition to the works already spoken of in other parts of the Review, numerous productions of more or less value in medicine, surgery, and the allied sciences. Hygiene, we are happy to find, rejoices in an increasing body of powerful supporters. The Medical Officers of Health of the City of London, Hackney, Whitechapel, St. Pancras, St. Luke's, Chelsea, and Islington, have published valuable Reports; and with them we may mention Mr. Blyth's • Minute of Information on Disinfection,' Mr. Gamgee's Letters on the Cattle Plague and Diseased Meat,' and Dr. Greenhow's Report on Murrain in Horned Cattle,' presented to Parliament.
In Medicine, we direct especial attention to the third edition of Dr. Budd's work. On the Diseases of the Liver,' which has fairly established for itself a place among the classical medical literature of England. The pathology of fever is represented in Dr. Bartlett's work, ‘On the History and Diagnosis of Fevers in the United States,' the original edition of which was reviewed at length by one of our predecessors.* Dr. Evans Reeves has published a volume On Diseases of the Stomach and Duodenum ;' while cardiac pathology finds exponents in Dr. Cockle and Dr. Markham, the former having published a paper On the Second Sound of the Heart,' the latter having re-issued Contributions to Cardiac Pathology, which first appeared in a cotemporary periodical, and the details of which will be found in the Quarterly Medical Report. Dr. Gull has republished in a separate form, the cases of paraplegia which have recently appeared in the Transactions of the Medico-Chirurgical Society,' and in the 'Guy's Hospital Reports.'
An elaborate memoir by Dr. Tholozan, ‘On Metastasis,' has reached us from Paris. The author regards the cases commonly set down as inetastases, as manifestations of the fundamental diathesis, and as independent of the other localizations of disease as these are of one another. An elaborate · Report on the Recent Epidemics of Cholera,' has appeared, by the pen of Dr. Hirsch, of Danzig, already favourably known as an earnest inquirer. Climatology is represented by Mr. Edwin Lee, who has published a brochure on the Hyères, the Isle of Wight of France; by Mr. Smart and Dr. Aitken, who have respectively written on the climates of the Crimea and of Scutari.
We may here also mention a book on the theory and treatment of stammering, by Mr. Urling, which has much to recommend it, entitled · Vocal Gymnastics.' Dr. Gairdner has thought it necessary to continue the controversy between medicine and homeopathy which
* See British and Foreign Medico-Chirurgical Review, vol. xviii. p. 357.
he so ably commenced in the Edinburgh Essays. We would earnestly recommend him, and all others who may be tempted to take up the cudgels, to act upon the principle enunciated in a passage of Dr. Gairdner's Few Words on Homeopathy,' and allow homoeopathists “ to remain, like the cuttle-fish, safe in their own ink.” Even the cuttlefish would choke if the sea did not wash away its ordure.
In Surgery, we have received a new work 'On Stricture,' by Mr. Henry Smith; the publication by Dr. Fell of the method adopted by him of treating cancer by the local application of caustics, has allayed all feverish excitement with regard to the subject, an excitement which the result scarcely appears to justify, either in a pathological or in a therapeutic point of view. Mr. Wharton Jones has brought out a Catechism of Ophthalmic and Aural Medicine;' a second edition of Mr. Hare's very useful Cases and Observations, illustrative of his mode of treating spinal deformities, and to which we drew attention in our April number, has already appeared. From abroad, Dr. Gay’s ‘Surgical Cases,' a reprint of a paper in which four cases of tumours of the extremities are discussed, have come to hand : with a French translation by M. Gosselin, of Mr. Curling's well-known work On the Testis,' with additions by the editor ; an important work by M. Broca 'On Aneurism ;' and another, deserving of attention, by Dr. Benedict, of Stockholm, On Hernia.'
The literature of Mental Pathology has received a ponderous contribution, in the shape of two large Blue-books, containing the · Report of the Scottish Lunacy Commissioners,' which have already excited public attention by the abuses which they expose; Dr. Hood's 'Decennial Report on the State of Bethlehem,' also deserves mention.
An able treatise On the Wave Theory of Light,' by Dr. Lloyd, will, with many of the works previously mentioned, receive fuller attention at an early opportunity; we shall also have a word to add concerning Mr. Fenwick's popular treatise, 'On the Causes and Prevention of Disease,' and of an iatro-theological volume by Dr. Duncan, entitled “God in Disease.'
Periodical literature boasts of numerous accessions. The most imposing is a quarterly medical review, published in Birmingham, under the title of “The Midland Journal,' the first number of which contains several papers by well-known surgeons and physicians. The dentists have brought out the first number of a Quarterly Journal of Dental Science,' which represents those of the fraternity who hold it better to constitute themselves a distinct body than to be associated with the College of Surgeons. The Imperial Society of Constantinople is represented by a monthly paper, bearing the title of Gazette Médicale d'Orient, the first number of which contains the commencement of an original article on miliary fever, by Dr. Tian, the compte-rendu of the Society during the first year of its existence; and a brief review of the cotemporary medical press. Our Dutch confrères have also issued a new periodical, under the title of Nederlandsch Tijdschrift over Geneeskunde,' under the authority of the Amsterdam Society of Medicine.
ART. I. Contribution to the Physiology of Saccharine Urine. On the Origin
and Destruction of Sugar in the Animal Economy. By GEORGE
HARLEY, M.D., F.C.S., of University College, London. In the summer of 1853 I communicated to the Société de Biologie de Paris the discovery of a new method of producing diabetes artificially in animals, by means of stimulants introduced into the portal circulation. Since that time I have frequently repeated, and even extended, my experiments with similar satisfactory results.
It is generally admitted by physiologists that the various secreting organs in the animal body are stimulated to perform their different functions either by a direct or by a reflex nervous action; and it has been said by Professor Bernard that the normal production of sugar in the liver is dependent upon the latter kind;-a stimulus being transmitted by the pneumogastric nerves to the brain, and reflected along the spinal cord and sympathetic nerve to the hepatic organ. M. Bernard was led to this conclusion by finding that immediately after section in the neck of both pneumogastric nerves, the liver not only ceased to secrete, but even the sugar contained in the organ at the time of the operation gradually disappeared. The division of only one of the pneumogastric nerves produced no visible effect upon the glucogenic function of the liver ; and if a sufficient length of time for the re-union of the divided nerve, eight or ten days, were allowed to elapse, a section of the opposite pneumogastric might be made without causing any interruption of the saccharine secretion. He further observed that the application of galvanism to the upper ends of the divided nerves not only reestablished the secretion of sugar, but if the current were continued a sufficient length of time, augmented it beyond the normal amount,-so much so that animals thus operated upon not unfrequently became diabetic. On the other hand, the application of galvanism to the lower ends of the divided nerves was not found to be followed by any such result. These experiments clearly indicated that the nerve-force which excited the liver to secrete saccharine matter did not travel from the brain, through the pneumogastric nerves, to the hepatic organ; but rather that the stimulus proceeded along these nerves to the brain, and was from thence re-transmitted to the liver by some other nervous chain.
The data yielded by other experiments, which it is at present unnecessary to recapitulate, induced M. Bernard to adopt the opinion, that in a healthy animal the reflex action which incites the liver to secrete sugar originates in the stimulus given by the respired air to the pulmonary branches of the pneumogastric nerves. He believes, in fact, that at each act of inspiration the tender filaments of the pneumogastric nerve distributed in the lungs receive from the inhaled gases a stimulus, which is transported through the trunks of these nerves to the brain, and reflected from the nervous centre along the spinal cord and splanchnic nerves to the liver. The point of departure of the normal nerve force which calls into play the glucogenic function of the liver, may at the first glance appear a matter of little moment; but when we consider that the secretions of organs increase in proportion to the amount of stimulus applied to their nerves, and that an excess of secretion which not unfrequently constitutes disease, arises in many cases simply from an exaggeration of the normal stimulus, we shall at once acknowledge the importance of thoroughly understanding the physiological, before attempting to remedy the pathological, condition of any organ. When an answer has been given to the query, “ Where is the sugar secreted ?" the question next in importance to the physician is most assuredly, “By what means is the secretion excited ?" A satisfactory answer to the latter question may not improbably furnish a guide to the successful treatment of a disease which has so long been regarded as ungovernable.
At present a great diversity of opinion seems to exist with regard to the cause of saccharine urine. Some authors speak of it as dependent upon a morbid condition of the liver, others as the result of disease in the nervous system, while a third class still adhere to the old opinion of its arising from disordered digestion. They appear altogether to ignore that one and the same symptom may spring from a multitude of causes, and that as saccharine urine is not of itself the disease, but only the most prominent symptom of a hidden complaint, it too may be the product of a variety of morbid actions quite distinct from each other, and consequently requiring diametrically opposite treatment. If, for example, the normal stimulus of the liver is exaggerated, an abnormal amount of sugar will be secreted; and if the quantity formed is greater than the amount requisite to supply the wants of the system, the excess which then acts towards the organism as a foreign body, will be eliminated with the urine, and the disease, diabetes mellitus, established. If, on the other hand, the stimulus, instead of being exaggerated, is abnormally feeble, a less amount of sugar will be produced by the liver than the wants of the system demand, and a disease which as yet we possess no means of recognising, will be the result. The presence of sugar in the urine does not, however, necessarily prove that the glucogenic function of the hepatic organ has been exaggerated. For even in cases where only the normal amount of saccharine matter has been formed, the sugar in the blood may be present in excess, in consequence of some diseased state of the system preventing its assimilation. In such cases, the sugar will gradually accumulate in the
blood, until at last the excess circulating in the body will act as a foreign material, and as such be eliminated by the urine.
Diabetes mellitus may further originate, either in such a change in the structure of the parts which secrete the saccharine matter as will admit of their performing more than the ordinary amount of labour, or in some organic change in the nerves which call the function into action, causing them to over-stimulate the sugar-forming apparatus. There are yet other two causes of diabetes sufficiently important to be here noticed. The first may originate in a foreign stimulus, in addition to the normal one, directly applied to the liver; the second, in such an artificial irritation of the nerves, as will excite them to communicate an excessive stimulus to that organ. A good example of the latter cause is to be found in the experiment performed by Reynoso, who discovered that by making an animal breathe irritating or stimulating vapours, the reflex nervous action might be increased to an extent sufficient to produce an exaggerated secretion of sugar, and to render the animal so operated upon for a time diabetic. This fact has been adduced by Bernard as a strong proof of the correctness of his view with regard to the origin of the normal reflex action. Without wishing to question the fact that irritation of the respiratory organs in animals produces a flow of saccharine urine, it may be remarked that, in making similar experiments, I have not found it so easy to arrive at the same satisfactory results which Bernard seems to have obtained. For example, I caused a robust rabbit to inhale sulphuric ether during seventeen minutes. In twenty minutes afterwards, and again in one hour and a half, the urine was tested without the slightest trace of sugar being detected. To another adult healthy rabbit, in full digestion, I slowly administered chloroform until he became completely insensible, indeed, much difficulty was experienced in restoring him. Two hours afterwards the urine was tested for sugar, with no better success than in the previous case. I compelled another rabbit to inspire ammoniacal vapours during five minutes, without being able to produce a flow of saccharine urine.
As the ill-success attending these experiments might arise from not giving a sufficiency of the respective stimulants, I administered to other rabbits a very much larger quantity; and in one case, the most satisfactory, I succeeded in detecting a small quantity of sugar in the urine. This result was not, however, attained until after I had rendered the animal five times completely insensible within twelve hours, by a mixture of chloroform and ether. * This success, although it confirms the observation of Reynoso, that the secretion of sugar may be augmented by an irritation applied to the pulmonary branches of the pneumogastric, even taken in connexion with the result of section of the cervical pneumogastric, does not appear to me to justify the conclusion of Bernard—that in the normal state, respiration is the excitor of the glucogenic function of the liver.
• Cases have been reported of sugar appearing in the urine of patients after the admi. nistration of chloroform ; but as this paper is a mere contribution to the physiology of saccharine urine, I refrain from entering fully into details. 39-xx.