It would seem from the foregoing observations that diabetes is associated with an organic change which may be briefly described as a destruction of the nervous matter along the arteries of the brain and cord. From the uniformity with which this was found in the five cases examined it may be presumed that there was a more than accidental connection between the symptoms of diabetes and the peculiar state of the nervous centres. The question presents itself whether the lesion is a result of the disease or its cause. The association of the morbid action with the blood-vessels suggests that it may be connected with the state of the blood; we know that the blood in diabetes is altered by the presence of sugar; is it to this that the deterioration of tissue is due ? Several considerations militate against this, at first sight, probable explanation. The veins and capillaries appeared to take no share in the morbid process though equally permeated by diabetic blood, which, in the capillaries at least, is brought into more intimate relation to the tissue than in the arteries. If the changes in the tissues were directly due to the altered composition of the blood, the capillaries could hardly fail to distribute its morbid influence. Besides this, the blood traverses the whole body without producing in any other organ an analogous failure of nutrition. We may probably abandon the view that the changes described are consequent upon the diabetic state of the blood, and have recourse to the supposition that the nervous alterations are antecedent to, and productive of, the glycosuria. The following considerations may be mentioned in favour of the latter supposition. No organic change has been found elsewhere to which the saccharine state of the urine can be attributed. The alterations in the brain are in their nature and situation exactly such as physiology has shown to be capable of producing that symptom. Further, we are the more disposed to regard the nervous changes as primary, by the fact that alterations similar in kind, though differing in distribution, occur, as belonging exclusively to the nervous system, quite independently of diabetes. This is the case particularly in the general paralysis of the insane. Dr. Lockhart Clarke has, since most of the preceding observations were made, described the lesions in that disorder, and shown that, though differing somewhat in situation, they are of the same nature as those here described. The conclusion that diabetes is primarily

and essentially a nervous disease accords with all that is known of its natural history; indeed, the opinion has, of late years, been gaining ground that the disorder is due to altered nervous action, though no structural change was known to account for it.

The urine often becomes saccharine in consequence of injuries of the head, apoplectic seizures, intracranial tumours, and other sources of cerebral irritation. These traumatic and accidental forms of the disease are, as we may believe, not necessarily accompanied by the grave and general lesions which have been under consideration. Several kinds of irritation, if acting in the right situation, give rise to a similar change in the urine, though often temporary, and for the most part unaccompanied by the serious symptoms which characterise what may be termed “idiopathic" diabetes.

Diabetes in its ordinary "idiopathic" form, though sometimes hereditary, and often taking its origin in causes which are not within our knowledge, continually results from circumstances which exert a depressing or otherwise injurious action upon the nervous functions; among these may be mentioned mental disturbances, rage, grief, auxiety and toil, and the various forms of dissipation among which sexual excess takes a prominent place. Causes of this nature may readily give rise to modifications of circulation in the nervous centres, and it has been shown that, as far as could be learned from the microscope, a widening or distension of the arteries was the initial change in the pathological series.

The foregoing observations concur in leading to the belief that diabetes essentially belongs to the nervous system, a consideration which may have a practical issue in modifying the treatment of the disease.

February 22, 1870.

GEORGE BURROWS, M.D., F.R.S., President, in the chair.

Present-68 Fellows.

Books were presented from Mr. W. Acton, Mr. R. Barwell, Dr. W. Hardwicke, Capt. Phelps, Baron Larrey, the Registrar of the University of London, and the Medical Society of Christiania.

John Livingston, M.D., was admitted a Fellow of the Society.

Robert Hamilton, Esq., and William Wadham, M.D., were proposed for election as Fellows of the Society.

The President then declared the ordinary meeting adjourned, and opened the

SPECIAL GENERAL MEETING,

relative to the amalgamation of the Medical Societies, which had been summoned by the following notice:

'53, Berners Street; Feb. 14th, 1870.

"Sir,-We are desired by the Council to inform you, that a Special General Meeting of the Royal Medical and Chirurgical Society will be held on Tuesday, Feb. 22nd, at half-past Eight p.m., precisely, for the consideration of the Resolutions adopted

by the Committee of Delegates on a proposed union of various Medical Societies now existing in London.

The President stated that in the reading of the propositions of the Joint Committee, their variations from the original resolutions would be pointed out; and after some questions by Dr. Webster, Mr. Macilwain, and Mr. Curling, as to the order of procedure, it was moved by Mr. Hulke, and seconded by Dr. Symes Thompson:

"That the Report of the Joint Committee be received and considered,"

which was carried unanimously.

After some remarks by Dr. Greenhow on the origin of the movement, the President explained the course which had been adopted last year, and Dr. Quain, stating that he considered the first Resolution

"I. That a new Society be formed, and incorporated by Royal Charter, under the title of the Royal Society of Medicine; and that this Society comprise Sections for the main branches of Medicine and the collateral Sciences,"

to be merely an abstract proposition, moved that it be approved, which, being seconded by Dr. Meryon, was carried nem. con., 37 voting for it.

After some informal motions, and remarks as to the effects of the approval of these resolutions, by Dr. Barclay, Mr. Henry Lee, Mr. Holmes, Mr. Birkett, &c., the second Resolution

"II. That the following Sections be formed:

1. A Medical Section.

2. A Surgical Section.

7. An Epidemiological Section, including also Hygiene

and Medical Jurisprudence.

Each Section will entertain questions of Therapeutics, Chemistry, and Physics, so far as they bear on its special subject "—

was moved, pro forma, by Dr. Pitman, as Chairman of the Committee, and seconded by Dr. Barnes, to which an amendment was moved by Mr. T. Holmes, seconded by Mr. John Birkett:

"That Resolution II stand as originally drawn up by the Royal Medical and Chirurgical Society" [which original Resolution introduces a Section of Physiology and Anatomy, and unites Medicine and Surgery in one Section].

After a long discussion relative to the formation of two Sections for Medicine and Surgery, in which Dr. Quain, Dr. Wilson Fox, Dr. Murchison, Mr. Hulke, Mr. Callender, and Dr. Tyler Smith spoke in favour of the separation; and Mr. Holmes, Mr. Birkett, Mr. Curling, Dr. Pitman, Mr. Christopher Heath, Dr. Greenhow, and the President in favour of their union, this amendment was carried by 44 to 13.

On being put as a substantive motion, another amendment was moved by Mr. Curling, and seconded by Mr. Brudenell Carter:

"That the adoption of each Section be proposed separately," which was carried by 32 to 6, and on being put as a substantive motion was again adopted.

Mr. Curling then moved, and Dr. Webster seconded:

"That Section 1 be a Medico-Chirurgical Section,"

which was carried nem. con., 39 voting for it.