Meatritionist

Mr. Astley Cooper, at St. Thomas's Hospital, having mentioned in one of his anatomical de- ?nonflrations, our views of the nature of diabetic disease, a young gentleman prefent, who had a relation in the country with the complaint, expressed a wish to be more particularly informed, and was referred to us. He gave a concise account of the Patient ; and it was suggested, as the Patient was so far advanced in life, an immediate application of our treatment to its whole extent might not be advisable ; the gradual adoption of it was therefore recommended. As the Patient, however, had been a Physician of long practice, though now retired, and being immediately under the care of a recyclable Physician in extensive business, we requested that our opinion in general might he conveyed along with the printed notes of Captain Meredith''s Case. This was on the 19th March 1797.

 The following account, written by the Patient himself,. we received on the 18th May, being only a period of two months. 

Guys Hospital, 18th May, 1797

 Sir, The enclosed account is drawn up by my friend the patient himself. I think it incumbent on me to return my best thanks for your kind and ready advice, from which the patient has derived so much advantage. 

I am, 

Sir, 

yours, &e

G. B. 

Dr. Rollo may make what use he pleases of the under described case, provided he does not insert the name of the Patient or that of his Physician. A gentleman far advanced in life, being now in his 77th year, and during the greater part of that time in pretty uniform good health, except some attacks of erysipelas about mid-age, and latterly a chronic rheumatism in the loins, occasioning more of stiffness than pain. He has been accustomed to live after the common mode of sober persons, or if prone to any excess, it was chiefly in the use of sugar. He began about two years ago to feel a great increase of general debility, to which was soon adjoined an unusual frequency of discharge by the bladder. The urine exceeded the quantity taken in by one third, and it was voided with a forcing kind of pain, both at the commencement and close of the emission; made softly in small quantities at a time. These calls became soon so multiplied in the night as greatly to disturb natural rest ; and the mouth and sauces grew so dry as to oblige the patient to keep small pebbles rolling continually in the mouth during the day time. The inflation of the saliva was such as to make it difficult to spit it out, unless previously diluted. The hands shook to such a degree that rendered it dangerous to shave, and hardly possible to write legibly, while the lower limbs felt as if force able to support the trunk of the body ; the feet and ankles swelled considerably ; the thirst was intense, but there was very little show of fever by the pulse. 

Under these circumstances the opinion of an eminent Physician in the neighbourhood was asked, who recommended lime water, earth of alum, afterwards pills of catechu, alum, and a small portion of vitriolated zinc. By these remedies the forcing at the neck of the bladder was a good deal relieved; but the very distressing dryness of the mouth and fauces still continued, and was by nothing so much solaced, as by moistening with milk and water. The urine remained, as it had always been, well coloured, frothy upon first emission, and favouring strongly of that sweetness, to scent and taste, charateristic of diabetic urine. 

Upon receiving from a young friend, a pupil at the Hospitals in Southwark, Dr. Rollo's notes on a case of this fort, the Patient and his Physician agreed to avail themselves of this plan of treatment, with some accommodation to the circumstances of the individual, and they have found reason to be satisfied with the adoption of it. 

Vegetable articles of diet had been long discarded; and the use of pure sugar, since the excellent hints in that communication, had been entirely laid aside. Rancid fats and putrescent flesh could not be admitted even in idea, without inducing nausea: instead of these were employed fresh mutton, animal gluten, mucilage, &;c. At breakfast he takes milk, with some cocoa, or chocolate; for supper, calves' feet jelly with milk, and sometimes an addition of sweet almonds. 

A moderate allowance of wine has been continued, as indefensibly necessary for support; but the least acid foreign wines have been used, and a gradual reduction is making in this hitherto necessary, indulgence. Of medicines, the saturated solution of soda, and Schweppe's soda water, have been only employed: from the last there is every reason to believe a share of the amendment may be attributed. See Dr. Falconer's letter to use where he points out the mephitic alkaline water as likely to be of advantage in this disease. 

Results:

The urine does not now considerably exceed the liquid taken in. In the day time it is voided frequently, but without pain ; the night calls are diminished to one, very rarely two occur. Its colour is good, and its sweetness can hardly be said to be perceptible. The excessive dryness pf the mouth and fauces, that depraved the taste for any aliment, particularly bread, and in consequence impaired the appetite, is nearly removed. The feet and ankles swell a little at times, which may be in some measure owing to the large proportion of the vvxQfittepov, during which, though the days are so long, yet the patient is unrecumbent sixteen or seventeen hours at least. With this hasty sketch you will please present my best compliments and thanks to Dr. Rollo.

From Mr. Houston, Brewer Street, London. 

L........... , aged about 30, fair complexion, light hair, and naturally of an extremely irritable constitution, in the month of February, 1793, received a violent shock by the death of one of her parents. On this melancholy occasion her grief was so very poignant, and at times so frantic, that serious apprehensions were entertained of a total derangement of intellect, and in this state she continued several weeks.

(several pages discussing the deterioration of her health leading to diabetes)

On their quitting the Wells, they, on their way home, stopped at Bath; and as her parent received benefit from the use of the waters of that place, they remained there eight weeks ; but before the expiration of the first fortnight, she found her stomach again disordered with heat and acidity, which in a short time increased to a height almost intolerable; the fauces were so sore, that it was a pain to swallow anything; and her tongue was equally so, being covered with a emit, or hardened slough on the top, and blisters round the edge. Her thirst was insatiable; to quench which, she ate a great quantity of fruit, and drank profusely of Seltzer Seltzer water and hock, but to no purpose.

Her skin was so parched, that the pores did not seem to emit the least moisture. To remedy this evil, some doses ofJames's powders were given, but to no effect ; towards the close of her time at Bath, she drank the waters for about a fortnight, they were supposed, however, to do more harm than good ; and growing daily worse there, she set out for London, where she arrived the 4th December, 1796. She immediately sent for her apothecary, who was greatly shocked ; as to all outward appearance, she seemed to be in the last stage of a consumption. Her pulse was exceedingly quick, but so feeble, that he could scarcely feel it, and so tremulous, that he could not with any certainty count or distinguish the strokes. For two days, he gave her every six hours a draught with kali ppt. magnef. alb. aa ^i, taken with half an ounce of lemon juice in the state of effervescence ; they agreed with her, and, as (he thought, cooled her; (he had no cough, but for some time back had loft her appetite, the stomach rejecting almost all solids; and when it did receive any, they generally laid heavy on it, or disagreed ; as some nourishment, however, was necessary, she was advised to eat eggs raw, or done very soft ; as also oysters and other shell-fish, as having a tendency to correct acidity. On the 3d day after her arrival in town (Dec. 6th) an eminent physician was sent for, who ordered a blister to be applied to her breast ; magnef. alb. qr. xv. in a draught every eight hours. These she took till the 15th, when she was ordered a draught with myrrh pulv. gr. xij. ferr. vitriol gr. iij. kali ppt. gr. viij. three times a day. This course she continued, with some trifling variations, but little interruption, till about the 19th February, 1797. By this time those medicines had the effect: of greatly recovering her appetite, and she had been allowed to eat such light animal food as she fancied ; but from this indulgence, of which she availed herself, with the return of her night's rest, which by this time she began to enjoy, she derived no other advantage than a small acquisition of strength ; for there was not the least appearance of bodily nurture, or any abatement of heat and acidity. 

The physician having compared the tardy, if any progress in amendment, with the quantity of food she was able to take, (for her appetite was greater than before her illness) began to discover symptoms of diabetes, and therefore gave orders to measure the quantity of fluids drank, and the quantity of urine she made and finding the latter exceed the former, he had some of it evaporated, and found it to contain a considerable portion of saccharine matter ; upon which she was advised to eat less vegetables and more animal food.

On the 18th, a gentle opening draught was given, though she usually took magnefia when any thing of the kind was necessary. On the 20th March, Dr. R. was consulted with her former physician ; and as he is already so well acquainted with all that has since been done, or happened, it is unnecessary for the writer of this to carry it any further.

Continuation by the Author.

On the 20th March, 1797, I visited the patient, with her physician and apothecary; she complained of a burning sensation at her stomach, which she faid was intolerable, with the sense of a sharp and hot acid rising into her throat ; her teeth were on edge, tongue red, and gums full ; she had little thirst, and was occasionally sensible of a moisture on the palms of her hands, and on other parts of her body ; her appetite was keen, and she never felt satisfied, but said that this degree of appetite had only been lately remarkable ; and she complained much of a burning sensation in her stomach, and of great acidity ; she was extremely emaciated, feeble, and inactive ; her skin dry, and rather warm ; pulse about 88 ; her urine of a pale colour, but to the taste scarcely sweet ; the quantity could not be distinctly ascertained ; it did not seem, however, to have been so increased as to engage any particular notice ; a little of the urine was evaporated; the residuum resembled treacle, but was salty to the taste, and the extractive matter did not seem much to exceed the quantity in healthy urine. On the whole, the adoption of light animal food, with less vegetable matter, and the medicines, had mitigated the disease. The physician who attended had a copy of the notes of Captain Meredith's case the preceding January, and he now very readily agreed to the animal diet entirely.

On the 14th April I saw the patient, with the physician and apothecary ; her looks had more the appearance of returning health ; she moved about with more agility and strength, though she complained of not gaining flesh ; her appetite is now good ; the tongue is clean, but not so florid ; she has no thirst ; the urine does not exceed a quart, a small portion of which being evaporated, the residuum was quite saline, and urinous in smell, but it was not evaporated so much as to determine the tenacity. The burning sensation in her stomach is diminished, and there is less acidity ; however, another emetic is prescribed, and the matter thrown up is to be examined, in order to ascertain whether it possesses acid properties. The patient informed me to-day, that for several years she has indulged in fruit, pickles, and sweetmeats.

April 25th. The emetic ordered on the 14th brought up very acid matter, which was found by the apothecary to effervesce with an alkali ; the urine deposits a reddish sediment ; she has less uneasiness at the fiomach, has more strength, and a more natural appetite ; her skin is moister.

May 10th. Very little change. Asafoetida is added to the pills, with calcined soda, and the quantity of the hepatized ammonia increased. From the delicacy of circumstances, an accurate enquiry cannot be made ; deviation of diet may happen ; in this cafe, we can only hope for a certain compliance with regimen, and a certain information with regard to appearances, and ultimately a recovery with tardy and irregular advances ; it merits much attention however, even with the view of discovering points of importance in the treatment, under the most unfavourable progress.

June 8th. Very sensible of an increase of strength, and that health is returning, the urine continues in a natural state, at least there is no saccharine matter. The heat of the stomach is much diminished ; the appetite feels natural ; no thirst or hectic symptoms ; she has discontinued our medicines, and only takes Schweppe's acidulous soda water, which she likes, and says it has been of much service in relieving the uneasiness of her stomach. To be allowed about four ounces of bread in the day.

June 16th. Since the use of the bread, the disease has been reproduced ; the urine is clear, and of a sensibly sweetish taste ; 18 ounces yielded a saccharine residuum of 1 ounce and 5 drachms ; her skin is again hot and dry ; the pulse quicker, thirst: intenfe, appetite keen, tongue florid and red ; alfo the heat of the stomach extremely unpleasant. She promises to return to the entire use of animal food ; her antimonial opiate to be taken at night; Schweppe's water for drink ; and a blister to be applied to the region of the stomach.

lid. The urine, in smell and taste urinous, having become so in twenty-four hours after leaving off the bread; her appetite is not so keen ; the tongue is not more florid than common, and the uneasy hot fenfation of the stomach is much less, though occasionally troublesome ; the thirst is gone ; the blister relieved the stomach ; the regimen, with Schweppe's water, to be continued.

July 14th. In a state of apparent recovery ; me occasionally takes a biscuit or two, but perseveres in the diet generally, and Schweppe's soda water. Next week she goes to Bristol, where she is to observe the fame conduct, being fully sensible of the influence of a change of diet, and equally so, that everything depends on her own steadiness. No accurate account could be obtained with regard to the quantity of urine ; in general terms it was said that it corresponded with the quantity of drink.

February 5th, 1798. Returned a few days ago from Bristol and Bath ; at the latter place she bathed in the warm bath, and was relieved, by its being followed by a moist skin. The Bristol water was very grateful to her stomach, and generally superfeded the use of Schweppe's soda water. She appears much in the same state as when I saw her in July ; the disposition to the disease still remains, and the feels better or worse according to her diet ; she eats daily some biscuit, and has done fo generally all the time the has been away ; the acidity of her stomach still continues a distressing symptom ; the urine yields a saccharine extract. 

March 6th. Since the first, has been strictly on animal diet ; the several symptoms are removed, and she appears altogether better than I have yet seen her.

March 21st. Continues better, perseveres in the diet. On the l7th she ate a sweet cake which was soon vomited in a sour state.

April 2nd. She assures me no change in the diet has yet been made ; she begins to loath food, but believes it is only animal food, as she feels a strong desire for vegetables ; and alleges that, even under the animal food, she has had the acid state of her stomach, especially at times when her mind has been uneasy ; tongue less red, indeed it is rather pallid ; the urine smells strongly, and has a greasy scum ; on evaporation, it yielded a saline and bitterish tailed residuum, without tenacity ; and when treated with nitrous acid, furnished scales. She was allowed a small quantity of broccoli, spinach, or salad, without sauce.

April 16th. In all respects better, and for these eight days has been eating broccoli and salad occasionally, without any reproduction of the disease.

April 18th. A portion of urine was examined, which was found clear, but of a urinous taste and smell ; its residuum, however, yielded oxalic acid when treated with the nitrous acid.

May 5 th. It was ascertained that she had eaten some biscuit between the l6th and 24th April.] Her skin is moist ; pulse 72, and regular; her appetite less keen, and she feels more uneasiness after eating, or rather has a sense of indigestion ; tongue clear, but not florid; she has gained flesh. She promises to leave off bread, and to take only cauliflower and spinach. The salad does not agree with her; she assures me, and so does her maid, that the other day, after eating more vegetables than usual, the urine smelt and tasted sour immediately after it was voided.

May 10th. Is again to visit Bath and Bristol ; she promises an adherence to the plan, though she acknowledges that her resolution is often likely to fail her; she will, however, be as steady as she can, being perfectly persuaded she has no other prospect of recovery but by so doing. She has again been sensible of the acid smell and taste in the urine, after vegetables. I examined her urine today, but it did not smell or taste of anything, except the urinous flavour and impression.

This Case, though not as yet completely terminated, appears to me of so much importance, that I have inserted it in its present progress. There can be little doubt, that the adherence which has been bestowed on the animal diet since the 20th March, 1797, has not only prolonged life, but given strong hopes of the re-establishment of as great a degree of health, as can possibly be expected, under a long continued stomach complaint. The exact period when Diabetes Mellitus was actually formed cannot be determined : it was probably when the keenness of the appetite took place, but when that happened cannot be accurately ascertained. She had been long subject to stomach complaints, and the keenness of the appetite is only noticed in the account about the lft March, 1797 whereas the cardialgia is mentioned as long before as May, 1796 ; and before these periods the health was much impaired. These complaints had been partly brought on by the circumstances so well related by Mr. Houfton, and partly by the frequent use of fruit, pickles, &c. The animal diet, though not unremittingly perilled in, yet by a more steady use of it in March and the beginning of April, the disease was so far overcome, that the urine became as near as possible to the standard of health. It is to be regretted that a further perseverance did not at that time follow ; however, the progress shows, that certain vegetables, such as broccoli, spinach, salad, &c. may be eaten at a proper time of the treatment, without reproducing the disease, while bread could not be eaten with impunity. This fact we consider of much advantage, as it enables us to guard against the effects of a long continued use of animal diet, and at the same time gratify, in some measure, our longing patient ; we say in some measure, because even these vegetables do not long check the ardent desire for bread ; indeed, the stomach appears very whimsical, for when it obtains its desires, other things are soon solicited. The circumstance of the urine having become acid after the use of more than the usual quantity of vegetables, is a curious fact, but as it merely rests on the testimony of taste and smell, we do not hold it, in this case, as satisfactorily ascertained; it deserves, however, to be kept in view.

Some Remarks on these Communications. 

The only circumstances leading to fix on the predisposing causes of the Diabetes Mellitus are contained, 

• 1ft. In Doctor Falconer's letter, where a case of the disease is related, as having apparently been produced by excessive indulgence in spruce beer, to reduce corpulency. 

• 2d. In Doctor Cleghorn's first cafe, where the patient had worked hard while under convalescence from fever. 

• 3d. In the cafe of the Gentleman of 77 years of age, who had been addicted to the use of large quantities of sugar.

• 4th. In Doctor Gerard's case, the patient had been subject to pyrosis, and liable to much perspiration previous to the diabetic attack

With respect to the treatment of the disease Doctor Duncan found, in one case, fat meats serviceable. 

Doctor Falconer recommends the mephitic alkaline water; and from the advantage the Gentleman of 77 derived from Schweppe's soda water, it may be of service. There is no doubt it will relieve the acescency of the stomach. We would prefer the soda water, as we think it may act less on the kidneys than that made with the vegetable alkali. 

Doctor Beddoes mentions a cafe where the Bristol water cured the disease. 

Doctor Currie has feen several cases of the disease ; but never saw a case of it with sweet urine cured. 

The Case of Walker shews the effects of the animal food. It was begun on the 29th December, when the daily quantity of clear sweet urine amounted to 13 pounds; on the 31 ft day, being two days only, the quantity of the urine was reduced to 5 pounds, and it had acquired a strong urinous smell. The two Cases, treated at Glasgow, by Doctor Cleghorn, shew also the good effects of the animal food, and of the influence of commotions in the bowels on the quantity of the urine.

The Case of the Gentleman of 77, likewise shews the efficacy of animal food ; but the most striking case is that of Clark, as related by Doctor Gerard. This important case points out, 

First. That in this disease there is no absorption of fluids by the skin. 

Secondly, That animal food may alone, if duly persevered in, cure the disease; and such perseverance may probably be of a very limited duration.

SECT. II. - Cases and Communications

the first Edition of the Work. From Doctor Marcet. London, January 12, 1798

MY friend and countryman Doctor de la Rive, having informed me that Walker had been readmitted into the Infirmary at Edinburgh, and placed under the care of Doctor Gregory, I requested him to send me an account of the further progress and treatment of the case, which I now have the pleasure to transmit to you. 

Continuation of the Case of Walker. 

June 12th, 1797. 

He had continued perfectly well till within this fortnight, though his urine, which amounted to 5.5 lb. when he left the Hospital, increased gradually to 16 lb. His thirst is at present urgent; his tongue is dry, as well as his skin, which is also hot; says that he sweats frequently ; pulse 108. He complains of a burning pain in the palms of his hands and soles of his feet; of confiderable weakness) and occasional sourness in his stomach, with pain and flatulence. His fleep is disturbed ; his ankles often swell at night. 

June 14th. In the last 24 hours he has passed 17 lb. of urine, which is of the common diabetic appearance. Su.aj. pulv. alum. comp. jfs. 4. in die; libat aquae calcis 2 lb. in die. Full diet, with meat for dinner. 

June 17th. Urine l6 lb. The dose of the compound powder of alum to be increafed to a drachm. 

June 19th. Urine 14 lb. and rather more limpid. The alum powder to be omitted, the lime water continued, and an entire diet of animal food to be adopted, confining of the following articles ; three eggs for breakfaft, four ounces of cheese for fupper, two pounds of meat for dinner, with three pounds of beef-tea in the day. 

June 21st. Urine 8 lb, ftill pale, though less so than before.

June 29th. Urine 5 lb. yellower than it has yet been and of a more natural smell.

July 7th. Urine 5 lb. To be allowed 4 ounces of bread daily, in addition to his diet. 

July 9th. Urine 5.5 lb. He has drank two cups of tea with sugar

July 11th. Urine 5.5 lb.; a portion of yesterday's was evaporated, and the residuum evidently contained saccharine matter.

July l6th. The bread to be omitted, and the animal diet strictly adhered to.

July 27th. Urine 5 lb. Within these few days his strength has been recruited. He is to be discharged. This Patient was detected in following his habits of irregularity and intemperance; indeed he could not be depended upon.

From Mr. Leigh Thomas, Surgeon, Leicester Square, London.

History

 I HAVE this morning (August 28, 1797) met with a confirmed cafe of Diabetes Mellitus ; and, as I consider it a favourable one for a trial of the ingenious mode of treatment you have pointed out for the cure of this disease, I shall be happy either to give it up to your entire management, or co-operate in any plan that may be suggested between us. The subject is a very industrious man, aged 38, by trade a watchmaker, much confined to business, and anxiously labouring for the support of a numerous family.

He is much emaciated, and loses strength and weight daily. He showed me a letter from a brother of his, living in Kent, who also complains of pain in the back, and great debility, with an occasional discharge of sweet urine, especially after any fatigue of body, or distress of mind. It appears that three brothers of this family laboured under the disease, but it could not be traced to either of the parents.

Treatment.

Doctor Rollo having seen the patient, and favoured me with directions how to proceed, he very readily agreed to adhere to any rules laid down for his recovery.

Sept. 2, 1797, he commenced eating animal food, and took six or eight drops of hepatifed ammonia thrice a day, with castor oil occasionally; his common beverage was water and beef tea. After pursuing this plan for days, the urine had entirely lost the sweet taste, and was greatly reduced in quantity ; by the 18th he had lost the pain in the stomach, and the appetite became more moderate. 

The quantity of urine was now reduced to one pint and a half; he felt very weak ; had a violent longing for vegetable food, particularly bread. I could not resist his solicitations, especially as I had a faint hope that the disease was conquered ; I therefore allowed him a small French roll, with a glass of port wine. The urine made that night was highly impregnated with saccharine matter, and increased to the quantity of five pints. The following day, he again indulged a second time with bread and also porter, and so continued to deviate till the beginning of November, sometimes taking three pints of porter daily. In this interval, I ordered him the cinchona and sulphuric acid. His strength was improved, yet he lost weight. The gnawing pain at the stomach had returned, and also the itching and excoriation of the prepuce, the urine very sweet, and had increased to ten pints. The disease being reproduced, and its effects so considerably increased, the patient promised to be more resolute in future. 

Nov. 20th, the animal food was again returned, and, I believe, faithfully adhered to until the middle of February ; the hepatifed ammonia was laid aside ; and milk was torbid, as I had strong reason to believe that it frequently produced sweet urine in the former trial. His strength, at the end of this period, was greatly reduced; the gums spongy, with frequent bleedings, a foetid breath, and a rigidity of the muscles of the lower extremities. The urine had decreased to three pints, not at all sweet, was of a brown colour, and loaded with putrescent mucilage ; in taste exceedingly salt, and much more pungent than urine in a natural state. The appetite was so completely destroyed, that the sight of animal food excited nausea, but, at the same time, there was a longing delire for vegetables and beer. His weight during this time varied something. In November he weighed more than nine stone ; in January, eight and a half; before the end of the course, he regained nine stone. 

The excoriation of the prepuce had gone off, but the natural propensities never returned ; the skin became moist, the clamminess of the fauces had disappeared. A great number of boils came out in different parts, which were exceedingly painful ; some few advanced to suppuration, but never afforded true pus. Every diabetic symptom having left him, and his present state being so very distressing, induced me to allow him a small proportion of vegetable food. As we had experienced the ill effects of bread in the former trial, I directed him to eat sparingly of potatoes, and drink weak brandy and water; he drank, also the alum whey. In two days after this, the sweet urine reappeared, and all the other symptoms soon returned. He never after this adhered to any regular plan, only taking vegetable food very sparingly.

About the middle of March, he had a severe attack of pleurisy, which required two bleedings, and other evacuations, to remove it. In April he passed some time in the country, twenty miles from town, where he constantly eat vegetables, and drank large quantities of mild ale; during this time, the urine was sweet only at times. Under these circumstances, he gained four pounds weight in nine days. After his return to town, his strength daily decreased ; the boils frequently appearing, obliged him to lie almost constantly in bed. During the latter part of this period, the urine was very frequently perfectly sour, and that immediately upon passing off, so as to leave no doubt of its being so in the bladder ; the taste and smell very similar to sour whey, but perfectly transparent ; at this time, it was always small in quantity. In the beginning of July, he had another attack of pleurisy, which terminated his sufferings on the morning of the l6th. (He died)

As I have merely given a summary account of the progress of the case, I shall, in like manner, relate the effects of certain vegetables upon the disease, and which came under my own observation, Bread certainly holds the first rank in exciting the formation of saccharine matter ; nor did this appear to depend upon the fermentation it had undergone, as the sea-biscuit, or a teaspoonful of flour in melted Butter, universally produced the same effect ; potatoes flood next ; onions, leeks, radishes, and turnips, also produced much sugar. Preparation by boiling, or otherwise, did not seem to increase or diminish their effects. Spinach, carrots, peas, broccoli, and cauliflower, had each less effect than the former, particularly the two last; parsnips were eaten with impunity. The urine never tasted sweet after taking them ; at first, the urine had a sourish taste and smell, which I attributed to them, but since, it has been perfectly sour, without being able to account for it. Every kind of fruit invariably produced sweet urine, without being able to ascertain any variation in their effects. Of Liquids, porter appeared the most hurtful ; no difference could be observed with regard to the effect of any of the spirituous liquors, wines, or cider; mild ale he considered as having no effect in producing the disease, but of this I can say nothing of my own knowledge, as he only drank it in the country. He was bled five times in the course of the treatment, purposely to examine the blood; in one instance only had the serum a turbid wheyich appearance ; the slightest taste could not at any time discover anything of a saccharine quality. Upon allowing the blood to evaporate in the open air, no putrefaction took place, it became a solid brittle mafs, of a mining appearance when broken. Dissection Twenty-four hours after death, under the directions of Mr. Cruikshank I proceeded to make a careful examination of the viscera.