with sulphuric acid, filter it and remove the salicylic acid which may be formed by ether. Evaporate this, dissolve in water, and test with perchloride of iron, when, if saccharin has been present, the well-known violet red colour will appear. As this test depends upon the formation of salicylic acid it is obviously inapplicable where salicylic acid is or may be present.

A New Test for Sugar in the Urine.—(Bull. Gén. de Thérap., Jan. 15, 1888) Marson recommends boiling the urine with pure ferrous sulphate and caustic potash when a dark green precipitate forms if sugar be present, and the supernatant liquid is reddish brown or black.

Antipyrin in Diabetes.-Among the other properties of this new drug Michard (Rev. Gén. de Clin. et de Thérap., May 24, 1887) has found it beneficial in diabetes in doses of half a drachm to a drachm and a half daily.

The Pathology of Diabetes.-J. Seegen (Zeitschr. f. Klin. Med. XIII., p. 267) was formerly a follower of Pavy but has changed his opinion, owing to recently discovered physiological facts. He now holds: 1, That sugar formation is a normal function of the liver. The quantity formed by the liver is very considerable, for a man weighing 80 kilogrammes, more than 1000 grammes in twenty-four hours. The sugar is decomposed in the body. It is formed from albumen and fat, while glycogen is formed from carbo-hydrates. Experiments show that the post mortem formation of sugar is not attended by diminution of the glycogen in the liver, while in starved dogs fed with fat only the blood of the hepatic vein contains more sugar than that of the portal vein. From his observations on diabetes he is forced to conclude that there is no necessary relation between increased glycemia and glycosuria. He distinguishes two types of disease which correspond to the slighter and more severe clinical forms. The first, in which the glycosuria depends on the ingestion of carbo-hydrates, is ascribed by Seegen to a disease of the liver cells, in consequence of which they are unable to convert

the carbo-hydrates in normal fashion. In the second he recognises a pathological alteration of cell life throughout the

organism, by virtue of which a greater or less part of these elements have lost the capacity of destroying the sugar brought to them by the blood.

In opposition to these views Girard working under Schiff (Arch. f. d. ges. Physiol., XLI., p. 294) finds that the liver post mortem converts a great part of its glycogen into sugar, and that if by disease the liver is freed from glycogen it forms no sugar, though the liver still possesses the power of converting peptone into sugar.

A New Remedy for Diabetes.-Quanjer (Weekbl. v. h. Nederl. Tijdschr. voor Geneesk., 1888, I., p. 251) recommends the use of the bark of syzygium jambolana in diabetes. He heard accidentally of its use in a case of diabetes, and employed it himself with very striking results on a diabetic patient.

R. Infus. Cort. Syzyg. Jambol. 30,0 to 300,0.

To be used in two days.

(This is a 10% infusion, and the quantity, about 10 ounces, is to be taken in two days.)

Paroxysmal Hæmoglobinuria.-G. Kobler and F. Obermayer (Ztschr. f. Klin. Med. xiii., part 2) produced, by artificial means (cold foot-bath and subsequent going out of doors), two attacks in a man, aged 49, the subject of this affection. Estimation of the hæmoglobin showed 90 per cent. before the attack, 85 to 90 per cent. during the attack, and 80 per cent. the next day. Enumeration of the red corpuscles showed 3,560,000 in the morning before the attack, 3,090,000 immediately before the attack, 2,890,000 during the attack, and 3,810,000 the next day. The incongruity between the amount of hæmoglobin and the number of corpuscles on the day following the attack may be explained by supposing that while the loss of red corpuscles is very rapidly made good, the newly formed elements are deficient in colouring material. The urine was strongly acid during the attack; its specific gravity was low; while the total nitrogen and phosphoric acid was diminished. In spite of the high temperature (396 C.) the urine did not present the character of febrile urine, and in

spite of the destruction of red blood corpuscles, their salts in the urine were not only not increased but were actually diminished.

Micro-organisms in the Urine.—F. Schweiger (Virchow's Arch. CX., p. 255) found that organisms injected into the renal artery soon appeared in the urine, and conversely when injected into the pelvis of the kidney could be found by cultivation in the blood. He attempted to determine where the passage takes place, but was unable to detect any in transitu, but, in opposition to Heidenhain's well-known observations, he found colouring matter (sulphuret of antimony) in the glomeruli generally between the epithelium of the glomerulus and the capsule. With reference to Wyssokowitsch's statement that bacilli do not pass through a healthy kidney, he says the necessary lesion would be so small that the point cannot be settled, but it is in favour of this view that a certain time always has to elapse before the passage takes place.

Lustgarten and Mannaberg (Vierteljahrsschr f. Dermat. und Syph., 1887, p. 905) examining the urethral mucus from eight healthy persons found it to contain ten different kinds of bacteria (four bacilli and six cocci). Of these ten there were two especially notable, one a bacillus showing the colour reactions of the tubercle bacillus, the other described as pseudogonococcus, differing in no respect from the gonococcus. It follows that it is necessary to be cautious in diagnosing from microscopical appearances alone either tubercle bacilli or gonococci in the urine. They found that it was necessary to take the precaution of drawing off the urine by the catheter to obtain a secretion which on cultivation is free from organisms. In three cases of acute Bright's disease they found in freshly obtained urine, numerous streptococci, which disappeared on the decline of the disease. They did not succeed in obtaining a pure culture of these.

MEDICAL PATHOLOGY.

BY GEORGE F. CROOKE, M.D.,

PATHOLOGIST TO THE GENERAL HOSPITAL, BIRMINGHAM.

Sewer-Gas Poisoning: A Cause of Albuminuria.-Brit. Med. Jour., March 3rd and July 14th.--In the above contributions Dr. George Johnson earnestly directs attention to a cause of albuminuria that seems to have been hitherto but little suspected, and so almost to have escaped notice entirely. He records, from personal observation, no less than five cases where exposure to sewer-gas emanations appears to have been the only discoverable cause of the symptoms. Two of them terminated fatally; one after six months' and the other after two years' illness; but both with all the clinical evidences of disorganised kidneys-the result of more or less continuous exposure to sewer-gas poisoning for a period corresponding to the duration of the illness. The papers also afford interesting examples of variability in the idiosyncracy of a number of persons exposed to the same danger. In the five cases quoted the kidneys appear to have borne the brunt of the attack; in others the gastro-intestinal tract suffered, for the patients exhibited symptoms of diarrhoea and dysentery; others, again, escaped with impunity. The rapid and progressive disorganisation of the kidneys in the fatal cases deserves serious notice, for it is a lamentable contrast to the apparently complete recovery of those where the cause was discovered early and so removed.

In another case that came under Dr. Johnson's care many years ago the patient, immediately after opening up a drain that had been blocked for some time, was seized with an acute and virulent attack of nephritis that went on rapidly to a fatal termination. It is also worthy of remark that some of his patients suffered from intermittent attacks of sore throat with pyrexia.

The pathology of the nephritis corresponds in nearly all respects with that of the nephrites complicating the specific febrile diseases; e.g., diphtheria, enteric, typhus, &c., and is to

be referred to the irritating effects of the poison upon the kidneys, which make every effort to eliminate it from the system. The perusal of Dr. Johnson's articles will put the general practitioner on the qui vive in similar cases, where the cause of the albuminuria requires to be cleared up.

Aneurism of the Cerebral Arteries of Syphilitic Origin."Annales de la Dermatologie et Syphilographie.”—Spillmann describes two cases of aneurism of the cerebral arteries terminating fatally by rupture and cerebral hæmorrhage. In the one case the aneurism was situated on the basilar artery, and the patient, aged twenty-seven, died eleven months after the primary infection; in the second case, the aneurism involved the circle of Willis and the patient, aged twenty-one years, had contracted syphilis eight months prior to his death. Histological examination of the wall of the aneurism disclosed the following changes: the adventitia was the seat of a dense small celled infiltration, the intermediate layer, corresponding to the muscularis, was, comparatively speaking, only slightly affected, while the intima was, in places, three times its normal thickness and composed of a richly nucleated fibrous tissue, that nowhere exhibited evidences of degenerative or fatty changes, such as characterise a non-specific endarteritis (atheroma). The aneurisms do not however necessarily rupture, for the cerebral arteries are sometimes found to be converted into fibrous cords with the lumen either extremely contracted, or else entirely obliterated; and hence the dilatation of the aneurism is arrested. In addition to his own cases, Spillmann has collected from literary records accounts of fifteen others in syphilitics, where death was caused by the rupture of the aneurisms, and he summarises the following conclusions: (1) Aneurisms of the cerebral arteries of syphilitic origin are not so rare as is generally supposed. (2) The basilar artery and the arteries in the Sylvian fissures are their favourite sites. (3) Their termination is usually in rupture, with symptoms of meningeal hæmorrhage. (4) They develop mostly in the later stages, more rarely some months after the primary infection. (5) In syphilis imperfectly treated, or allowed to run its course