of a blue colouring matter, which appeared to be intimately associated with saccharine transformation. It was a significant fact that sugar in the urine occurred not, as a rule, in the first urine secreted after a more or less prolonged suppression, but subsequent to the occurrence of albumen; and that whilst there was during the early stage of cholera convalescence a relative deficiency of urea when albumen was present, sugar, on the contrary, was associated with urea in excess. The deficiency of urea which occurred in connexion with the albuminous urine of cholera was the more noticeable from the fact that, as the amount of urine secreted within a given time, after the previously complete suppression of it, was small, the proportion of urea should have been relatively increased, if the development of that organic principle in the system had been uninterrupted; and consequently it might be suggested that, as urea had been found to be one of the best diuretics, the suppression of urine which occurred in cholera and in allied conditions of the system resulting from poison or from disease, admitted of being directly referred to temporary arrest in the formation of that excrementitious product. The production of the blue colouring matter in the urine of patients suffering from cholera was chiefly important from the fact that it was very closely associated with the development of glycosuria; the occurrence of sugar in the urine in such cases appearing to be simply a somewhat later stage in the series of pathological changes which, so far as they affected the urinary secretion, could be traced to one common origin. Attention was directed to the frequency of the occurrence of a blue colouring matter in the urine in a great many other diseases which, like cholera, admitted of being more or less directly referred to the alimentary canal; and it might be suggested as probable that, as sugar had also been found in the same class of cases, those two abnormally increased, if not altogether abnormal, constituents of the urine were due to the same cause, and derived from the same source. In reviewing the pathology of the urine in cholera, the chief facts to which attention should be directed, with reference to the occurrence of glycosuria, were-the suppression of the urinary secretion as a primary result of the disease, with arrested formation of urea; albuminuria, with deficiency of urea; the presence of a blue colouring principle; and, finally, diuresis, with excess of urea

and sugar in place of albumen. In the sequence of phenomena there indicated, urea as the essential principle of the urine necessarily occupied the chief position; and the subsequent presence of sugar during the stage of convalescence, when albumen was no longer present in the urine, suggested that the temporary glycosuria of cholera might be due rather to the progress of reparation than of destruction, and that it was, as it were, the result of an excess of restorative effort on the part of the system to repair loss from previous disease. This suggestion derived support from what occurred in diabetic patients during an attack of fever, when sugar in their urine was apt to be replaced by albumen; and by what occurred in the same class of patients during the last agony, when a similarly retrograde course with respect to the pathology of the urine was pursued; for in them also the urine became albuminous, and the sugar disappeared; and it was moreover supported by a large amount of collateral evidence which was almost conclusive in its favour. It would be found useful, in studying the character of the glycosuria which had been observed during convalescence from cholera, to take into consideration the various physiological, pathological, and artificially produced states of the system in which, as in cholera, sugar was commonly present in the urine without giving rise to confirmed diabetes. For temporary glycosuria, like the previous suppression of urine, had no claim to be regarded as an exceptional phenomenon, which was in any way characteristic of cholera; but, on the contrary, it would be found to occur during convalescence from other forms of acute disease, in which it was often associated with the previous development of a blue colouring principle in the urine. It would be found also to occur, apart from disease, as a physiological condition during certain stages of development, and at certain epochs of life. And, finally, that it admitted of being experimentally produced. With reference more especially to the occurrence of temporary glycosuria in the latter class of cases, as a result of sympathetic nerve section, the author remarked that in all experiments of that kind the primary effect produced must be on the vascular system to which the branches of the sympathetic nerve were distributed, and that any effect produced on other parts of the organism must be secondary to that. Consequently, whilst recognising vascular paralysis as the primary

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result of section of the sympathetic nerve in all parts of the system, it was important to notice that in the secondary results produced no such constant uniformity had been observed, since these were liable to vary according to the locality in which the experiment had been performed. He was of opinion that, with regard to the occurrence of temporary glycosuria as a sequel of cholera, there was no fact in experimental physiology more significant than that observed by Eckhardt in 1867, of the absence of sugar from the urine after section of the splanchnic nerves, which, taken in conjunction with the fact observed by Moreau in 1868, that section of those nerves was followed by an intestinal flux, possessing the same characters as the flux of cholera, indicated very clearly the direction in which the inquiry should be pursued. For when the neuroparalytic condition of the digestive canal so produced was compared with what occurred after the influence of the central portion of the sympathetic nervous system had been artificially increased by the application of galvanism or electricity to the part during life, as shown in MM. Linati and Caggiati's experiments, it would be found that the results then obtained were essentially opposed to those which followed arrest or diminution of that influence, either from section of the nerves or from cholera.

In conclusion, the author remarked that the temporary glycosuria which had been observed in all the various cases which he had cited might be regarded as a consequence of long-continued and immoderate secretion, consequent on a previous diminution or arrest of the influence of the sympathetic or vaso-motory nervous system, which apparently occupied a position functionally midway between the secretory surface on the one side, and the supply of blood on the other, and thus became the moderator of secretion in virtue of its action as controller of the circulation. From his observations on the subject, he had been led to infer that all secretion was associated with saccharine transformation; and that whilst, on the one hand, an excess of secretion was accompanied by a corresponding excess in the formation of sugar and consequent glycosuria, a moderate exercise of secretory function was, on the other hand, accompanied by a correspondingly moderate formation of sugar, which was not more in amount than could be disposed of in the system; and that it was only when the blood contained

sugar in excess from such causes as those which had been already referred to that some of it was, in consequence, eliminated by the kidneys. Consequently, it might be urged that the temporary glycosuria, which occurred as a sequel of cholera, served to show that during reaction from previous collapse there was a temporary excess of restorative effort, and that although, as was well known, an abortive attempt at reaction was in that disease a very common cause of death, yet in those cases of cholera which terminated favorably, and in which glycosuria had been observed to occur during convalescence, the subsequent disappearance of sugar from the urine might be accepted as evidence in favour of the normal balance of organic function having been satisfactorily restored, and that the tendency to excess during recovery from a central arrest of nutrition had ceased.

January 10, 1871.

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

Present-31 Fellows and 5 visitors.

Books were presented from Dr. Althaus, Dr. Blandford, Dr. Cleveland, Dr. Elam, Dr. B. W. Foster, and Dr. Alex. Halley; Mr. T. B. Curling, Mr. George Gulliver, and Mr. T. Holmes; the Secretary for India in Council, the Royal College of Surgeons, the London Institution, and the Obstetrical Society.

The following communication was read:

On the Duration of Phthisis, and on certain Conditions which Influence it. By C. T. WILLIAMS, M.D., Assistant Physician to the Brompton Hospital. (Received November 8, 1870.)

(Abstract.)

THE author commences by stating that he uses the term "phthisis" in a broad sense, to signify consuming pulmonary disease, attended by a well-known group of symptoms; and includes under it, besides tubercle, all states of the lung which tend to excavation and caseation.

The object of the present paper is to give some account of a thousand cases of phthisis selected from the private practice of Dr. Williams and the author, and to deduce the amount of influence which the conditions of age, sex, family, predisposition, and origin exercised on the duration of the malady. The patients belonged chiefly to the upper and middle classes. The cases have been taken from the records of those who first consulted Dr. Williams between 1842 and 1864, a period of twenty-two years; the ground of selection being that each case has been at least one year under observation.

Sex.-The author, after explaining how the cases were recorded and exhibiting certain tables, states that 625 of the 1000 were males and 375 females.

Age. Taking the sexes collectively, 41 per cent. were attacked between twenty and thirty, 25 per cent. between thirty and forty, 191 per cent. under twenty, and 13 above forty. Considerable difference was found to exist between the two sexes as to the time of attack. Between twenty and thirty, the most common period of attack for both sexes, about 7 per cent. more females were attacked than males; and, again, between ten and twenty, 11 per cent. more. On the other hand, after thirty, the reverse was the case. Between thirty and forty the males exceeded the females by 111 per cent.; and above forty, by 6 per cent. The average age when attacked was, for the males, twenty-nine years and a half; for the females, twenty-six years.