in the urine. I scarcely thought, however, until recently, that the effect was so constant and so marked as it appears to be. A result was one day obtained in my laboratory, which induced me to seek for further experience on the point. Chloroform was being administered to an animal, and, whilst the urine which escaped at the commencement, gave no reaction with the copper solution, that withdrawn about twelve minutes later, produced an orange-yellow reduction. The animal had been simply kept under the influence of chloroform during this time, without any experiment being performed. The extent of time during which an animal is kept under the influence of chloroform, seems to have little or nothing to do with the amount of sugar to be met with in the urine. In an instance where anesthesia was kept up for between three and four hours, there was only at the end of this time a slight amount of sugar in the urine. It has appeared to me, from what I have seen, that the effect has been dependent on the extent of struggling and congestion attendant on the exhibition of the anaesthetic, rather than on anything else. Upon noticing the above-mentioned occurrence, where the urine became so rapidly and so strongly saccharine, I thought it would be interesting to be able to speak personally of the effect of chloroform in this respect, upon the human subject, from an examination of the urine in a number of cases taken indiscriminately from the operating theatre of Guy's Hospital. My pupil, Mr. Lamb, who has often rendered me much assistance in my laboratory, kindly undertook to collect for me twenty cases. The following is a list of them, with the results. They were procured during the summer of 1861. The urine examined was the last passed before, and the first passed after, the inhalation of chloroform. Examination of the urine for sugar in twenty cases, from the operating theatre of Guy's Hospital, before and after the inhalation of chloroform. 15 Joseph S 16 Jane W 17 Louisa K 28 Amputation of forearm No reaction 27 Removal of necrosed No reaction tion. Slight reaction Slight reaction. 14 Operation for club foot No reaction 2 Removal of necrosed No reaction bone Considerable reaction. Slight reaction. Considerable reaction. Considerable reaction. 66 Amputation of thigh No reaction Strongish re 36 Removal of necrosed No reaction bone 24 Removal of tumour of Slight reaction action. Trace of reac tion. Moderate reaction. Considerable reaction. breast Considerable 20 Charles T 41 Amputation of foot No reaction reaction. Considerable reaction. From this table it appears that out of twenty cases in which chloroform was administered for anæsthetic purposes, to patients undergoing various operations, in only one (No. 10) was there no effect upon the urine discoverable. In most, the reaction afforded after the inhalation was a considerable one; and in some, quite a strong one. In four of the cases, it will be observed, the urine collected, before the administration of the chloroform, gave a slight indication of the presence of sugar. It is no uncommon occurrence for the urine of patients to behave in this way, and give more or less reaction with the copper solution, without being submitted to concentration or any special process of preparation. Mr. Long and Mr. Gibson, whilst acting as clinical reporters at Guy's Hospital for Dr. Rees and Dr. Gull, tested the urine of a large number of patients labouring under various complaints. They found in several cases, and particularly in cases of phthisis, that the copper solution afforded a more or less strongly marked reaction. In some of the results that were shown to me, quite a fair amount of sub-oxide deposit had been thrown down. STATE OF THE BLOOD.-I apprehend that a certain state of the blood circulating through the liver is required for the proper performance of its functional operations, and that certain unnatural states of it may cause a retrogression of the amyloid substance into sugar. A supply of portal blood seems necessary to hold in check the saccharine metamorphosis; for, strikingly enough, a ligature applied to the portal vein causes the blood circulating through the system to present a strongly saccharine character. Let us pause for a moment, and look at this result in reference to the glyco-genic theory. It will hardly, I think, be found to be reconcilable with the admission of the doc trines that have given to the liver a sugar-forming function. If there were the constant production and flow of sugar from the liver through the hepatic veins, as is implied under the glyco-genic theory, on interrupting the principal stream of blood through the organ, it would certainly be only reasonable to expect that less sugar should escape, and less sugar be found in the circulatory system. Yet, as the result of actual experiment, it would appear, that precisely the reverse happens to be the case. Notwithstanding the current is so reduced, which is supposed to be carrying sugar into the general circulation, as a part of a particular functional operation; the amount of sugar now reaching the circulating fluid is actually very greatly increased. Apparently, in accordance with the facts of the case, it may be said, that the ligature of the portal vein places the liver in an unnatural condition: that the functional working of the organ does not proceed, with a supply only of arterial blood, in the manner it does, when there is also the stream of portal blood to exercise its influence. And, as the result of this, the amyloid substance descends into sugar, like it does under many other unnatural states of the liver. Ligature of the hepatic artery as well as the portal vein, causes the liver to become strongly impregnated with sugar during life, as is the case with ligature of the portal vein only; but the blood belonging to the general circulation remains uninfluenced. The flow of blood through the liver being entirely prevented, no opportunity is afforded for the passage of the sugar into the system. The introduction of an acid into the system so as to alter the natural quality of the blood, I have found to produce saccharine urine. This effect has followed the injection of phosphoric acid into the general venous system, and also its introduction into the intestinal canal. I conceive it acts by altering the state of the blood, and rendering it unsuited for contributing towards a natural performance of the operations carried on in the liver. Dr. Harley, some years since, found that the injection of small quantities of ether and ammonia into the portal system determined the presence of a certain amount of sugar in the urine. M. Lecomte, also, has noticed that saccharine urine may be occasioned by the administration of small doses of the nitrate of uranium. I take it, again, in these cases, that the functional working of the liver is disturbed through the medium of the fluid traversing its vessels. STATE OF THE NERVOUS SYSTEM. - By depriving the liver of the force it naturally derives from the nervous system, the chemical tendency of its amyloid substance to transform into sugar ceases to be held in check; and thus a saccharine state of the whole system may be rapidly induced. A diabetic condition of the urine may, indeed, be occasioned by simply destroying life and keeping up the circulation artificially for a time. The life of an animal, for example, is destroyed; the chemical tendency of the amyloid substance is allowed to come into play. Sugar is immediately formed in the liver, and diffuses itself into the blood-vessels. It is only now necessary for the circulation to be maintained, and a saccharine state of the urine will be produced. The circulation is easily kept up after death by the performance of artificial respiration; and where this has been carried out, it has been found, as above mentioned, that the sugar formed in the liver, as the result of a post-mortem occurrence, has been carried to the kidney and eliminated with the urine. One hour's performance of artificial respiration has sufficed to give a fair quantity of urine presenting a highly saccharine character. In the result that has just been referred to, life has been |