the waste of tissue is at its maximum. But I altogether doubt this statement, and certainly in the class of cases now brought before the Society this condition of affairs is reversed. The patients ordinarily remain in fair bodily condition, lose very little flesh, and bear the aspect of health; they are languid and lethargic while the attack is present, and take little exercise; their appetite is good, though their zest for food is impaired; and their principal complaint is of dyspepsia, prostration, and nervous derangement, so that they are often regarded as simply nervous and hypochondriacal. In short, it would appear that the azoturia must have some other source than the wear and tear of the tissues, and there are only two probable explanations of its occurrence the one that it is referable, in part at least, to the production of urea from the elements of the food during the primary processes of assimilation, as a consequence of perverted nervous action; the other that a larger quantity than usual of the nitrogenous elements are secreted by the kidneys in consequence of a defective secretion of nitrogenous matter by the bowel. The recent experiments recorded by Dr. Parkes would seem to show that this latter is at least a possible explanation, and unless, in any given case, the urine and the excreta from the bowels could both be examined, it cannot be affirmed positively that it does not afford a solution of the mystery. But it appears far more feasible to suppose that a certain portion of the food, instead of being utilised in the system, undergoes conversion into urea, and is then excreted without having fulfilled its mission in the animal economy. In the class of cases under consideration, the bowels are not more than ordinarily torpid, nor is there any evidence of defective intestinal secretion, whereas there are marked symptoms throughout of disturbed digestion and of perverted nervous action.

Several circumstances lead me to believe that this affection is more nearly allied to gout than it is to diabetes, as suggested by Dr. Prout. In the first place, not a trace of sugar was detected in the urine in any instance, though it was invariably sought for. Secondly, no less than eleven out of the twenty-seven patients were the offspring of gouty parents, and three of them had actually suffered from gout. Thirdly, the urine was often highly charged with lithates, and occasionally threw down crystals of uric acid, indicating a strong tendency to the lithic acid diathesis. Fourthly, in most instances the quantity of urea appeared to vary inversely as the quantity of uric acid. I speak hesitatingly on this point, because, unfortunately the amount of uric acid, in each specimen of urine was not determined by analysis; but when the urine proved, as it usually did, clear and often pals at one time, and high coloured and loaded with lithates at another, the urea was invariably found to exist in largest quantities, as shown by the crystallization of nitrate of urea in those specimens of urine which were free from lithates, although the quantity of urine voided on those occasions was larger than when the lithates were deposited, If, on further examination, a direct relationship should prove to exist between the quantity of urea and uric acid excreted in these cases, another link would be added to the chain of events which appear to exercise a bearing on the causation of gout. At present my information on the subject is too imperfect to warrant such a conclusion, but I have deemed it expedient to draw attention to the facts as far as I have hitherto ascertained them.-Medico- Chirurgical Transactions, Vol. 51, 1868, p. 45.

37.-ON THE ALLEGED EFFICACY OF THE PEROXIDE OF HYDROGEN AND OZONIC ETHER AS REMEDIAL AGENTS IN DIABETES MELLITUS.

By Dr. F. W. PAVY, F. R.. S., Assistant-Physician to, and Lecturer on Physiology at, Guy's
Hospital.

[Dr. Pavy furnishes the following paper in answer to many enquiries which have been made of him as to his experience of the action of peroxide of hydrogen in diabetes.]

Amongst the various remedies that have from time to time been proposud,

upon theoretical grounds, for diabetes, oxidising agents hold a prominent position. It has been a favourite idea to regard this disease as arising from a defective oxidation of sugar in the system. Bernard even admits that at one period he was in lined to look upon the artificial diabetes arising from his operation of puncturing the floor of the fourth ventricle as due to a disturbance of respiration leading to an imperfect combustion of sugar in the system. He continues by stating. however, that he was obliged to abandon this theory in the presence of new facts with which it did not accord; and afterwards asserts that it is not by combustion that sugar disappears in the

system.

As oxidising agents, the permanganate and perchlorate of potash have been, in their turu, proposed; and more recently, attention has been bestowed upon the peroxide of hydrogen and ozonic ether. A case reported by Dr. Day of Geelong. in the pages of the Lancet for January 11th, 1868, brought these latter agents into prominent notice, and led to high expectations being entertained regarding their efficacy. Dr. Day, after dieting a patient suffering from diabetes, and trying the various medicinal remedies recommended for the complaint, without effect, began to reflect in the following manner upon his case. While pondering," he says, "over the hopeless condition of my patient it occurred to me that if I could oxidise the sugar that had been taken up in the general circulation, it would be an approach toward the natural mode of its elimination by the lungs. With this object in view, I gave half-drachm doses of the ethereal solution of peroxide of hydrogen, mixed in an ounce of distilled water, three times a day." From the report that follows, an astonishing improvement took place in the state of the patient; and in seventeen days, in the place of an extreme state of distress, we find her condition stated to be as follows: "Says she feels as well as ever she did; never felt better in her life."

Looking at this case as it stands, nothing could be more satisfactory than the result depicted; and I am sorry, for the sake of therapeutics and those suffering from diabetes, that my own experience does not substantiate the conclusion that might be drawn from it. I have tried both the aqueous and ethereal solutions of peroxide of hydrogen in the complaint, but have not been able to perceive that the slightest benefit has been produced.

A few weeks after the report of Dr. Day's case appeared, I tried the aqueous solution of peroxide of hydrogen in several cases, and closely watched, with the assistance of the students of Guy's Hospital, the results. The agent was obtained from Mr. Robbins, of Oxford street, and administered in two drachm doses three times a day. There was not the slightest effect traceable upon the quantity of urine, quantity of sugar passed, or the symptoms of the patient. One patient, indeed, expressed himself rather indignantly upon having what he conceived to be only water administered tobin. I have since tried the ethereal solution of peroxide of hydrogen, or, as it is called ozonic ether; and will furnish the details of a case in which I have recently employed it in Guy's Hospital, and in which a daily analytical examination of the urine was made.

The patient, a man aged 29, had been the subject of diabetes, without any complicating affection, for a period of nearly a year. Upon admission into the hospital, he was placed upon a restricted diet, the food allowed cousisting of meat, bran biscuits, eggs, greens, and beef-tea, with three ounces of brandy a day. An astringent mixture had recently been ordered, to check diarrhoea, from which he was temporarily suffering. For five days before the ozonic ether was commenced, the state of his urine was as follows :—

:

Ozonic ether was now administered in half-drachm doses with water four times a day, and without any other medicinal agent. No alteration was made in the diet. The diarrhoea under which the patient had been formerly labouring, had previously disappeared. The ozonic ether was continued for nearly three weeks; and the following is an account of the state of the urine during the time :

It will be seen from the above report that there was no marked effect either one way or the other observable upon the urine. What slight effect there was, was the reverse of improvement, the urine being higher in quantity, and the sugar larger in amount, towards the end of the period during which the ozonic ether was administered than at the commencement. patient, as regards his general feelings, expressed himself as not perceiving much difference; if anything, he thought that he had been feeling a little more thirsty, and that his appetite was not so good.

The

I have come across several cases in private practice in which the ozonic ether has been tried. In none have I been able to learn that any benefit was produced. Indeed the fact of the patients coming to me may be take as affording evidence that the result was not satisfactory. One patient whom I have recently been attending was glad that I proposed making known my experience, as he had been worried on all sides by this friend and that to try the new remedy for diabetes, as it was called. He took it for two months, and in speaking about it expressed himself in anything but friendly terms towards it. He had lost his appetite, he said, under its use, and I had to listen to a category of other evils that he was sure had been produced by it.-Lancet, March 13, 1869, p. 358.

38.-CASE OF DIABETES TREATED WITH THE PEROXIDE OF HYDROGEN.

By Dr. W. H. DAY, Physician to the Samaritan Free Hospital, and to the Infirmary for Consumption and Diseases of the Chest, Margaret Street.

One or two successful cases are not enough to warrant judgement of the merits of any drug; we must have case after case yield which has obstinately resisted other therapeutic measures before we can pronounce of its worth. If a remedy can be found to control the excessive loss of fluid which is going on in diabetes, and to improve the general condition of the system, we may hope with a careful diet and regimen, to prolong life for many years in comfort, if not to cure the disease itself. The case of the late Dr. Camplin is a

very remarkable one of what may be done with care and judicious management. The specific gravity of his urine, which at one time was as high as 1040, fell to 1016, and without a trace of sugar; but the improvement was more from the diet than from any medicine. The good that has been achieved in the present case must be due to the medicine employed rather than to the diet, which has not been carefully observed. The patient has throughout eaten moderately of ordinary bread, and violated the rules laid down by drinking porter frequently. In other respects his diet has consisted chiefly of eggs, fish, and meat.

J. H., aged 57, by occupation a messenger, experienced good health till April, 1868, when he became very weak and languid, lost flesh, and had no appetite. He was told by a medical man that his kidneys were sound, although at this period he passed an excessive quantity of urine. For many years he was addicted to drinking a great deal of beer, but lately he has reformed. In November, 1868, when I saw him for the first time, he was too feeble to walk across the room, and was very worn and emaciated; indeed he could not support himself in an upright posture. He was afraid to eat, from the extreme flatulence and inability to digest food. The action of the heart was very feeble. The liver much exceeded its natural limits, and there was considerable fluid in the peritoneal cavity. The superficial veins of the abdomen were enlarged. The legs were very anasarcous, shining and pitting on pressure, and there were dark ecchymosed spots which threatened to burst. I prescribed the nitro-muriatic acid with taraxacum and gentian, and ordered him to drink a little brandy-and-water. Two days later the specific gravity of his urine was found to be as high as 1045, and to assume the deepest brown colour on boiling with liquor potassæ. During the day and night he passed between ten and twelve pints of very faint straw-coloured urine. As the acid mixture seemed to suit, I told him to continue it, and ordered in addition, two drops of creasote in the form of a pill three times a day. He also took dilute phosphoric acid with glycerine in barley-water for an occasional drink, although his thirst was less than I have observed in a case of diabetes. There was another unusual feature in this case: the bowels were almost always moved regularly every day without aid from med cine.

On the 24th of December, as he was not making any satisfactory progres I determined to give him the ethereal solution of peroxide of hydrogen in half-drachm doses three times a day, in an ounce of water, omitting all other medicine. Three days later the dose was increased to one drachm. A remarkable change for the better at once set in; the urine was reduced in quantity, and the appetite and strength improved.

March 3d. He has increased fifteen pounds in weight, and looks altogether another person. His liver is greatly reduced in size, and the abdominal veins are much less prominently marked. No fluid can be detected in the cavity of the abdomen, and the amount of tympanitis is only slight. There is scarcely a trace of oedema in the legs. Dr. Savage, who requested me to look after this patient, concurs with me in attributing the improvement to the employment of the peroxide of hydrogen.-Lancet, March 20, 1869, p. 396.

39.-REMARKS ON THE TREATMENT OF DIABETES BY OZONIC ETHER.

By A. E. WILMOT, Esq. Bridlington, Yorkshire.

[Mr. Wilmot has had the opportunity of testing the effects of ozonic ether in three cases of diabetes. These cases were attended along with Dr. Hutchinson, of Bridlington.]

Its administration in each case was attended with most satisfactory results, and the patients expressed themselves relieved from the most distressing symptoms. In the first place, it has a most powerful influence upon the cutane ous, nervous, and vascular system, imparting a glow of warmth to the surface of the body, and stimulating the glandular element of the skin. Secondly, it assuages the painful feeling of constant thirst, in some cases more than others, but in all in a marked degree. Thirdly, it allays restlessness, no doubt from the anaesthetic effect of the ether. Fourthly, it diminishes considerably the quantity of urine voided-in fact, in two out of the three cases, reduced it to the normal amount. The first case (that of a stout elderly lady who was passing seven pints of characteristic secretion in the twenty-four hours) is now apparently quite well; the saccharine matter has disappeared, and the water is normal in quantity. The second case is that of a tradesman who was becoming rapidly emaciated, and passing on an average seven pints and a half of highly saccharated urine in the twenty-four hours-the quantity is now reduced to three pints. The progress of emaciation seems checked. This patient had occasion to leave home for a time, and ceased taking the ether; his symptoms soon became augmented. The third case, that of diabetes in a lady, is complicated with advanced disease of one kidney; but even with that disadvantage, added to its chronicity, the quantity of renal secretion has been brought down from about four quarts to three pints and a half in the twentyfour hours, although it varies in amount. This patient, on coming under treatment, was too weak to hope for much improvement; but her condition, otherwise distressing, is now converted into one of comparative comfort. Fifthly, the elimination of sugar by the kidneys is lessened, probably either by the ozonic ether controlling the excessive elaboration of that material in the liver, or by influencing the hepatic portion of the organic system of nerves, and enabling it to resume its normal function of determining the formation of glycogen by the hepatic cells, thereby converting saccharine elements into an oxidisable substance which becomes resolved into carbonic acid and water, and, in that condition is constantly cast off by the depurating organs of the body.-Med. Times and Gazette Dec. 12, 1868, p. 680.

40. THE THERAPEUTIC VALUE OF BELLADONNA IN REFERENCE TO DISEASES OF THE BLADDER AND URETHRA.

By REGINALD HARRISON, Esq., Assistant Surgeon to the Royal Infirmary, Liverpool, and Lecturer on Anatomy at the School of Medicine.

I propose briefly to allude to some advantages I have observed to follow the use of belladonna, local and general, in certain disorders of the genitourinary system.

As a topical application I have used it with benefit in some of the more obstinate forms of stricture, especially those consequent on injuries of the urethra. Referring back, we find some of the surgeons of the last century strongly recommending it where spasm was present, to produce relaxation; but as we are now provided with remedies more certain in their action for combating this complication, this drug has naturally fallen into disuse.

It is not, however, in reference to any antispasmodic influence it may possess, that I purpose to allude, but to the power which I believe it has of directly influencing and effecting a change in the obstructing materials. I was first induced to give it a trial in these cases by observing the benefit that followed its application to cicatrices, and growths of a fibrous character resembling them; in one instance especially, an unsightly deformity on a young woman's forehead, the constant application of the extract of belladonna produced a very decided effect; the cicatrice, though not disappearing, became much softer, more like the healthy skin around it, but what was of still more importance, it lost almost entirely the tendency to contraction which is so productive of such painful deformities. I have used it with undoubted advantage in other cases, and I therefore had reason for anticipating an equal bene