Meatritionist

From Doctor Storer, Nottingham. October 18 1797

THAT the cure of the Diabetes Mellitus had hitherto been a desideratum in Medicine, the candid declaration of Dr. Cullen will leave no room to doubt; and though I have reason to think that there exists in certain families a morbid disposition, occasionally showing itself in profuse and sweet urine, thirst, eagerness of appetite, and feverishness, which is relieved by medicine, disappears of itself for a time, and recurs upon any irregularity, much as happens in dyspepsia, yet I think a distinction ought to be made between this milder and more chronic species of the disease and the true Diabetes Mellitus, with rapid emaciation, as described by yourself and others. Respecting the latter, (of which seven distinct cases have fallen under my care) I must say with Dr. Currie, that after the disease was completely formed, I have never seen it cured by the former methods of practice. 

The first notice I had of the new method, was from your notes of Captain Meredith's case, transmitted to me by Dr. Aldrich, (the Gentleman of 77, see page 180,) with a request to have my sentiments respecting the propriety of his pursuing a similar plan. I have reason to think that the Doctor's disease had existed a considerable time, before it was detected in September 1796, when he first complained to me of oedematous legs, great thirst and dryness in the mouth, without any corresponding degree of fever, increasing debility and frequent irritation to urine, the quantity and properties of which had not been observed, the Doctor having strongly adopted the idea, that it was more the infirmities incident to advanced life, than any positive disease under which he laboured. Having declined to recommend anything till the state of the urinary discharge was ascertained, I soon received a note to say, that the colour, taste, smell, consistence and saccharine residuum, after evaporation, all proved the urine to be truly diabetic. In consequence of this information, the Doctor was advised to give up all visits, and pass the winter entirely within his house, to abstain from vegetables, sweet and home made wines, to which he had been, particularly partial, and all redundance of sugar, of which he was fond, and to pursue the plan of medicine stated in his letter to you. Under this treatment six months elapsed before your method was known to us, during which the Doctor was in some respects relieved; the progress of the Diabetes appeared to be arrested, but all its characteristic symptoms still remained. The sequel of the case, from the end of March till the 18th of May, (the date of the report transmitted to you) is better related by the Doctor himself, than I am able to do; to this report I have only to subjoin that on the 17th of June following, 

He found himself able to pass two days here (20 miles from home) on a visit. The swelling of the ankles was no more than what is customary at his age; he appeared as well as he had been for several years; and though his urine had a flight sweetness, it was neither too abundant nor otherwife defective. This state of health continued, although he had in a great measure resumed an ordinary diet (abstinence from vegetables and saccharine matters excepted) till the 14th or 15th of July, when he was seized with a cholera, at a gentleman's house in the neighbourhood; and though the bowel affection ceased, so as to admit of his being removed home, yet on the 18th I found this truly excellent and learned man in a dying state, without any other symptoms than those of debility and dyspncea; his urine was natural. The Doctor himself has stated that he would not consent to enter upon your plan of regimen in the Uriel manner that I would have recommended it to be pursued, at least for some weeks. He entirely rejected any hepatised ammonia, or any nauseating medicine. It was as a substitute for these that I proposed the soda water of Schweppe, having come to the knowledge of a diabetic case in Lancashire; which was understood to have been much relieved by that preparation; and I entirely concur in the Doctor's own opinion, that while it was a solace to his thirst, he derived other advantages from it. In fine, the benefit he experienced from the whole of the plan, much exceeded his expectation and mine; and I do not think, at his age, the cure could have been more complete. 

It is with much concern I remark, that in patients under the influence of Diabetes, there is such an invincible desire for variety in aliment, and often such an aversion to animal substances, that the new method of treatment most often fail for want of a fair trial. I have at this time a man of about 50 under my care, who has laboured under this disease for two years, and who has had all along a disgust to the taste, smell, and often fight of animal food. Six months ago, I strongly recommended to him your plan of regimen; he tried it partially, I believe, without much evident effect and soon abandoned it. Taking advantage of the rapid increase of his diforder lately, and the near prospect of dissolution, if nothing essential was done, I have again enforced it with all my powers of language. The consequence has been, a fresh trial of two days, which he declares himself unable to support, and now he appears to resign himself to his fate.

R. Redfearn M.D. of Lynn Regis, Norfolk

"I therefore immediately suggested to him the propriety, and the absolute necessity, of abstaining ridigly from all fermented liquors and vegetables, with everything else that could impart oxygen to the system by the primae viae; and at the same time ordered that his diet should consist principally of fat beef, pork, and such ailments as were of a gross or unctuous quality, and most likely to produce hydrogen in the greatest abundance. After this patient had persevered in the above medicines and regiment during a fortnight only, he found his thirst by no means so excessive. The quantity of his urine was considerably diminished, and became also of a quality more urinous, and less sweet. His amendment continued to be progressive, without feeling any interruption, either from natural or adventitious causes; and he was completely free from every symtom of the disease in less than three months after the medicines were first administered. He never once deviated from the regimen prescribed. My patient has now continued perfectly well for more than eight months, and to my enquires, very lately, he declared, that he never enjoyed a better state of health, than he does at the moment."

From Mr. Shirreff, Deptford. February 23d, 1798.

A YOUNG LADY, who has lately completed her 12th year, of a thin habit of body, tall of her age, of a docile disposition, and who has a regular flow of spirits, subject, however, to sick headaches, and accustomed to eat much fruit, sweetmeats and pickles, has become affected with Diabetes.The months of June, July, August, and September, 1797 were passed in Devonshire, near the sea-coast, where she bathed in the sea, and used exercise on horseback. She returned to this neighbourhood early in October with apparently an improved constitution. About the latter end of November she had an attack of angina; the left tonsil became enlarged, as well as the submaxillary and other glands of the same side. The angina went off; but such a state of glands remained as indicated a scrofulous constitution. After the indisposition, she did not recover her usual appearance of health; the wings of the nostrils became enlarged, the upper lip tumified, and the infide of the left nostril red, and excoriated; she had alfo flight herpetic eruptions. Early in the month of January her spirits became deprefled, her disposition indolent, and equally indifferent to study and amusement. She complained of headache and flight cholics; she became thinner though her appetite remained unimpaired. About the middle of February she had an intense thirst, and frequent calls to void urine. These were attributed to an improper habit; and she was retrained from the former, as the latter was supposed to be the consequence. The restraint, however, was impracticable.

At this time I was made acquainted with the circumstances. I desired the urine to be preserved; and on examination, it was evidently characteristic of the Diabetes Mellitus. I sent a portion of it, with an account of the case, to Dr. Rollo (it furnished the purest saccharina extract he had met with, and which granulated by keeping). I directed a diet, consisting chiefly of animal substances; an opiate combined with an antimonial at bed-time; the extremities to be anointed with a liniment of hog's-lard and camphor.

February 24rd. Her thirst was great; her appetite was keen; she had frequent headaches; a costive habit of body; a bitter taste in her mouth, with frequent nausea; her nights were good, but when obliged to get up to void her urine, which was frequent, her skin was cool; no rigors, or local affection in the kidneys; the abdomen was not enlarged, but there was an evident hardness above the pubis, embracing the region of the bladder; her skin, however, put on an appearance which requires a little more attention. Upon her arrival from the seacoast, I have observed she was much improved in her looks, as well as in general health, which was nowhere more conspicuous than in the appearance of the surface of the skin. Being subject to herpetic eruptions, I was accustomed to remark the lingular dryness upon the surface, and particular feel, which seemed inconsistent with health; but after her arrival from sea-bathing; these irregularities had disappeared, and the skin of her arms and neck had a natural look; but now appearances were worse than before, and such as struck me forcibly: the skin was dry, harsh, void of elasticity, shrunk, of a leaden hue, and seemed to adhere to the muscles; one would have supposed that there was no cellular membrane, being not only void of fat, but the motion of the skin was also trifling; in a word it seemed to be what is called hide bound. An emetic was directed in the evening, and the body was to be rubbed with the liniment, to which had been added a solution of the sulphuret of potash. 

February 25th.

The urine is of a deeper colour, and less sweet; an abstinence from liquids was recommended, so far as it was practicable. With my patient I called on Dr. Rollo; we agreed on the plan of treatment, which was to consist of an entire use of the animal diet; as drink, a dilute solution of the sulfurated potash in water, and two grains of the extract of hemlock, with one grain of the antimonial powder at bed-time. February 26th.

Yesterday she ate voraciously at dinner; was put into the warm bath in the evening, and the skin afterwards anointed with a preparation of hog's lard and pure ammonia. She had a good night, and without any occasion to void urine. This morning the urine is high coloured, and saltish to the taste; indeed it might be considered as natural urine.

February 27th. 

I was informed that the urine voided yesterday at one o'clock was free from sweetness, and perfectly insipid; some time after it appeared natural; but two hours after dinner was sweet, and in the evening again apparently natural. She was directed castor oil, being costive : the bath and injunction to be continued, and likewise the diet.

February 28th.

Has had a good night; the urine this morning is evidently urinous, though of a pale colour; her thirst diminishes, and her appetite is less keen; the skin feels softer. Yesterday she ate bread at breakfast, which I was informed of immediately afterwards in paying my morning visit. I was determined not to lose this opportunity of watching through the day any changes in the urine. That which was voided until dinner time, was sensibly sweet. I evaporated three pints of it, and it yielded of a saccharine extract a quantity amounting to 8 ounces 3 drachms. Her dinner was entirely animal food, and what (he passed afterwards deposited a lateritious sediment, and in colour, smell, and taste, differed very little from natural urine.

March 1st. 

She had a good night; the thirst diminished; urine more natural in appearance. She continues the regimen, See. and is ordered to try small doses of the powder of ipecacuanha.

March 3d. The urine differs little, either apparently in quality or quantity, from what is natural. Allowed her boiled milk and bread for breakfast this morning. At 1 o'clock this forenoon, the urine not sweet. She is to be indulged with a biscuit at dinner, and another at tea in the afternoon. The urine was examined at bed-time, and it was found very sweet. 

March 4th. The urine voided in the night was insipid, this morning saltish. Visited Dr. Rollo with my patient. Continuance of the animal food recommended, and occasionally a trial to be made with a small quantity of bread.

March 6th. Urine very sweet; complains of thirst and headaches. I suspected she had been deviating, which was acknowledged; she promises a more ready adherence. 

March 9th. She is able to take three biscuits in the 24 hours, without the production of sweet urine; but if this quantity is exceeded, the saccharine matter is perceptible. Therefore the assimilating powers are now able to convert a certain proportion of bread with animal food into proper chyle, which is capable of being applied to the purposes of nutrition.

March 10th. The appearance of the skin is much altered for the better. Medicines and diet to be continued. The weight of the body was this day found to be 64 pounds.

March 15th.

Nothing particular has occurred these five days past. She has been cautiously increasing and diminishing the quantity of biscuit, according to the effects produced; the number of biscuits has not exceeded three or four, and the fourth generally produces sweet urine.

March 23rd. From the 15th to this day nothing material has happened. The urine voided in the interval of her meals is insipid, and is falter and more urinous the farther distant from the meal. On the night of the 22d the body was covered with a general moisture. 

March 24th. This morning the weight of the body was found to have increased, since the 10th, five pounds and upwards.

March 28th This day I have augmented the quantity of biscuit, The patient's health now improves daily.

March 29th. The additional quantity of biscuit has reproduced the sweet urine, though in a less degree. The number of biscuits to be diminished.

April 9th. During the holidays there has been a great deviation from the plan. On Good Friday she ate sweetened bread; on the Sunday following, sweet cakes and sweetmeats. These were repeated yesterday, with sugar to her tea. In the evening she voided 7 ounces of urine, highly saturated with sugar. The above irregularities were carefully concealed; but thirst, headache, and sweet urine, betrayed the deviation. Being alarmed at such a relapse, she promises more steadiness in future,

April 12th. The urine natural. She takes the biscuit.

May 4th. The whole plan now consists in regulating the quantity of bread; when a large proportion is used, sweet urine is still reproduced, and of the saccharine matter she is sensible, by the peculiar feel of uneasiness about the meatus urinarius. The skin is very soft, and appears different from what it did at the commencement of the disease, and for a long time afterwards; her appetite is good, but not particularly keen; she is not troubled with third; her sleep is undisturbed; no headache, nor any local pains about the kidneys—the tension of the region of the bladder is removed; her spirits are good; her strength returns, and she practices her juvenile studies with alacrity; the disposition, however to the disease is not yet removed.

May 6th. After having returned to the diet she has been accustomed to, before her illness, fweet urine was again reproduced, and which I apprehended before its examination, from the change in the appearance of the skin, of the neck, and arms.

May 16th. Since the 6th, her diet has been very strictly attended to, and the injunctions particularly so; the urine is not sweet.

May 31st. Since the 16th, our patient has been progressively increasing the quantity of biscuits and farinaceous substances; she can with impunity this day confume six biscuits, and the whole produce is disposed of by the assimilating powers. The urine is natural, but on Tuesday the same quantity of bread produced six ounces of water, highly saturated with sugar. The bulk of the body is increased; she is active and capable of using exercise without fatigue. I still persevere in the use of frictions, and anointing the body; the cold bath is recommended, and will be used, for the first time, on Monday next. She has been for some time using bitter and chalybeate medicines.

June 3d. The patient ate some green peas without producing sweet urine. The skin looked florid, the muscles strongly marked, and fuch a general appearance of health as had not before been observed for many months. The bread was this day diminished, lest the usual quantity added to the peas might be more than could be disposed of.

June 4th. Evaporated some of the urine; less animal substance in it than what has hitherto been observed. No sweetness in her urine, which in flavour and colour does not differ from what is natural.

June 6th. Quantity of bread considerably increased without any inconvenience occurring. Medicines, frictions, and injunctions continued; moderate exercise is recommended and used. Formidable as the Diabetes Mellitus has been hitherto found, it can now be moulded to the wish of the practitioner. To remove the disposition to the disease may be difficult, but an important advantage is gained, as we now can cure the unpleasant and most distressing symptoms, and bring the disease into a mild state, which may ultimately be eradicated by regimen and medicines. What may be the extent of time before my patient can get free from the disposition, it may be impossible to ascertain; I have no doubt, however, of its accomplishment, though it may remain until after those changes in the system have taken place, which are brought about at the age of puberty. While the case continues under my charge, every attention shall be followed, and the event shall be communicated to you. 

In the management of this curious disease many reflections on its nature have arifen, but as, these have led me to adopt your opinions generally on the subject, I shall for the present reserve them. In the meantime it gives me some satisfaction to have contributed my share, so far as one case extends, towards elucidating some points in the history and progress of the disease, especially in the changes the urine undergoes at different times after eating, and according to the substances eaten.

From Doctor Jameson, Royal Artillery. Tynemouth, 1st March, 1798. 

ROBERT NIXON, a Collier, belonging to the works at Benton, about six miles from this place, of a slender make, dark brown hair and complexion, aged 22, and whom I visited on the 29th of December, 1797 informed me, that about two years since, he was induced to work very hard in the damp coal pits, which, he supposes, exceeded his strength and abilities, from an anxious desire to support his aged parents; that he then used to sweat greatly while at work in the mine, and to drink at the same time very freely of cold water, having no opportunity of procuring other liquor. From enquiry, I have reason to believe that he was not addicted either to inebriety or excess in eating, previous to the attack of his present disease : ardent spirits, I was assured, he never tailed ; and no beer or ale-house being nearer his habitation on Benton Moor than two miles, he says he had neither inclination nor opportunity for procuring in the intervals of labour, the common, though perhaps ncceilary indulgence of malt liquor ; and that he feldom tailed it oftener than once a week, and never drank to excess. His food, previous to, and since his indisposition, has been milk, or weak tea, and bread, in the mornings and evenings ; fresh meat for dinner four or five times in the week, with a small proportion of vegetables ; at other times fresh or felted fish, and occasionally pork; the colliers rearing hogs about their huts, in the same manner as is done by the negroes in the West Indies. The bread that the poor people use in this county, is a mixture of about equal parts of second flour and rye meal, of their own baking, and generally unleavened. Since his sickness (at the same time that he has complained of constant thirst) he has also had a keen appetite, but I did not understand that it could at any time be termed voracious. He says he could eat heartily, and more than even himself thought prudent, as his food generally after eating lay heavy on his stomach, and, in his opinion, also increased his thirst ; but he very seldom rejected his food or drink. On the first attack he felt himself languid, and unequal to his customary exercise: had a particular weakness in his knees ; pain in his loins ; unpleasant dry sensation in the mouth and face, with frequent desire for drink; and in describing the progress of his complaint to me, he dwelt much on the excessive dryness of his skin, and entire want of perspiration from the beginnings which he was induced to take particular notice of, from having been remarkably disposed to sweat previous to his illness. 

The debility, and other symptoms, obliged him to leave off work about 18 months since, and soon afterwards he put himself under the care of a Surgeon in the neighbourhood ; he also had the advice of a Physician in Newcastle. Previous to his application for medical assistance, he had not attended to the sweetness or increase of his urine, though I have no doubt but that these symptoms existed also from the beginning of his other complaints. The Physician and Surgeon whom he first consulted, pronounced his disease to be Diabetes, and put him under a course of astringents and the customary remedies. These he continued for some time, but with no permanent advantage ; he was therefore induced to discontinue all kinds of medicines for an interval of several months ; during which time his disease became gradually worse, and reduced him to a very feeble and emaciated state. 

It was at this period of the disease, and after at least 8 months continuance, that he employed Mr. Burnet, (an ingenious young practitioner of the town of Shields) on the 10th of December, and I have been obliged to take the history of the symptoms and progress, previous to that time, from the patient himself, and his friends; as I have not the pleasure of knowing either of the two gentlemen under whose care he was at first, I have therefore endeavoured to be as accurate as possible in taking the minutes of the case before Mr. Burnet, in hopes they may tend to throw some light on the cause of the disease, or elucidate any circumstances connected with its future progress. 

When Mr. Burnet first saw him, he made about 12 quarts of urine in 24 hours, (as measured by his sitter) of a straw colour and sweet taste. His appetite keen, and third exceflive, but the quantity drank during any particular period has not been hitherto ascertained. Bowels inclined to costiveness. Skin dry, and without perforation. He had oedematous swellings of his legs, and was so weak as to be scarcely able to walk across the room. Pulse about 80. Restless at night, with frequent headaches. 

He was directed to take on the 10th a grain of opium every night at bed-time ; and as I had had an opportunity previously of conversing with Mr. Burnet on the subject of Diabetes, and giving him a perusal of your publication on that subject, he readily entered into the plan of cure suggested there; which the Patient was desired to adhere to rigidly as far as concerned the regimen ; being strictly forbidden to eat any vegetable food, and to be guided in that respect by the rules you have laid down. He was, however, at the same time ordered an astringent mixture of bark and alum, of which he was to take a spoonful frequently ; and this he continued until I saw him on the 29th. During the interval from the last to the 29th of December, a quart of his urine had been evaporated on each of the following days. 

On the 12th, leaving three ounces of a thick . Saccharine extract, in smell and appearance like treacle. On the 20th, two ounces and a half of the same kind. On the 26th, two ounces ditto ; and on the 29th, one ounce and two drachms, evidently mewing a progressive degree of convalescence ; which was also confirmed by a very considerable abatement of all the symptoms; his third in particular had almost left him, and the quantity of urine was diminished to about two quarts in 24 hours. He said he had made 5| quarts the last three days and nights previous to the 29th, as measured by himself. (The extract was weighed by Mr. Burnet.) 

On the 29th, when I visited him, though heartedly declared the great advantages of the plan he was pursuing, even in so short a time, he still, however, complained of considerable debility, some pain about his loins, and dryness of skin, with a degree of 26; of restlessness and headache ; but his third and appetite were so moderate, that he found very little self-denial necessary now in abstaining from much food or drink. His mixture had griped him, and occasioned a little sickness at stomach; I therefore advised it to be omitted; and the next day he took 60 grains of the kali sulphuratum, given in 10 grain doses, He was directed to have two small blisters applied to the region of the kidneys. The opium at night to be continued, with an occasional aperient, and to wear a flannel shirt next his skin consistently. The regimen of animal food, &c. to be very rigidly adhered to, and the quantity of liquid taken, as also his urine, carefully measured, and both it and the egeila kept for inspection. 

On the 4th January, 1798 

On visiting him again, I found the blisters had not been applied, but that he had taken the kali sulphuratum as directed; his skin cool and moist; pulse 79 ; says that he perspires much in the night time, and that his sleep is less disturbed; the flushing of his face, oedematous swelling of his legs, and temporary headache, have almost entirely left him, and he is gaining strength fail. One quart of his urine had been evaporated the day before, and the quantity of extract from it was an ounce. The smell and quantity of his urine little different from natural, and the quantity of the extract much the same as on the 4th. The kali sulphuratum had been omitted ; and though he has taken but very little of any hepatic or narcotic medicines, his progress towards recovery has been very rapid since the plan commenced; and the diminution of the quantity of the residuum lingular in so short a time.

January 16th. Found him not so well as I expected, the plan of cure having been deranged, and retarded confiderably, by the unfortunate circumstance of his brother-in-law (on the 11th) losing his leg, by an accident in a coal-pit; his dependence being entirely upon him, he could not now get proper and regular diet. 

Mr. Burnet had also rather prematurely substituted a strong aromatic tincture, which I found him taking, and which might probably, with other circumstances, have tended to disorder his bowels, as he said he had a tendency to diarrhoea for some days past I proposed his taking an emetic and omitting the tinclure; but the emetic was not given him. The evaporation of his urine had also been neglected. He was much better, and the diarrhoea had ceased. The progress towards recovery is by no means so rapid as for some time prior to the 11th, though he appears to gain ground ; his skin moist; appetite and thirst moderate. One quart of his urine, on evaporation, yielded about an ounce of the extract as before. 

He was under great depression of spirits, and unhappy from considering himself an incumbrance to his brother-in-law's family. Said he thought himself sufficiently recovered to work for his bread anywhere but in the pits, and would seek employment ; and as I saw this was likely to frustrate the hopes of a complete cure, I proposed taking him into the Artillery Hospital at Tynemouth, where he could have been very well accommodated in a room with the Hospital Steward; and attested him I would maintain him, and I hoped, complete his cure, without any additional expence whatever to himself or friends. The lad himself anxiously wished to embrace the proposol, but it was otherwise opposed; and on my calling again on the 24th February, I was informed, that he had gone to work in the mine again; but after a few days trial, finding his strength inadequate, and the disease gradually returning, he went to Burtley, near Chester Street, about 18 miles from this, where he hoped to meet with easy employment; and I have not had an opportunity of seeing him since. 

I think from the great progress towards a cure, considering the time, there is no doubt but had the plan been followed up under more favourable circumstances, it would have terminated successfully. It was my Intention to have been guided entirely by the new theory of this disease, and to adhere strictly to the plan suggested by you ; but I could not get the gentleman who attended him, to abide entirely by it; and as Nixon had little assistance from medicine, the rapid progress at one time towards a cure, is therefore principally to be attributed to regimen, and the advantage of originally a good constitution. Previous to the attack of this disease, he had been a very healthy young man, without scrofula or other complaint, and accustomed always to the plainest and simplest food. The pain in the region of the kidneys ceasing soon after commencing the treatment, renders it probable they were not morbidly affected; and the sympathy or connection between the stomach and skin, in his disease, from the beginning, was remarkable.

Tynemouth 1ft July, 1798. 

ON riding past Benton yesterday, I inquired after Nixon, and found he had returned, and been employed in the colliery there as a pitman, about nine days. His strength and appearance were greatly improved. He says, the only remains of his complaint, are some degree of weakness, and lassitude, particularly after working; he also makes rather more urine than when in his former health, which in quality is apparently natural. The edematous swellings of his legs, third, and other bad symptoms, have disappeared. On the whole, I consider him a successful instance of what the regimen suggested by the new theory of the disease can effect, even with little other assistance, when the constitution is originally good, and the habits of the patient not previously vitiated.

The other three patients were women, of whom one is married, aged 24, fair and delicate. Her disease began eight months ago, while she was giving suck, and she was very soon compelled to wean her child. She was admitted on the 8th of March, extremely weak and emaciated; her urine, which was very sweet, amounting daily to 15 lb, at least. 

Together with animal food, laxatives, and emetics, she got hepatised ammonia; and for many weeks she has been so well that she is about to be dismissed cured.

The other Patient is a widow aged 29, of a sallow complexion. About four years ago, after delivery, she was dreadfully pained about the umbelicus, where a large tumour arose and suppurated. Matter flowed from it for six months, during which time she was reduced to extreme weakness ; but the wound having closed, she recovered tolerable health, and enjoyed it till two years ago, when Diabetes attacked her. She was admitted on the 19th of April, was treated in every respect like the last, and like her, is to be dismissed cured this week.

The third is an unmarried girl, aged 22. She was admitted June 5th, when her urine daily exceeded 14 lib. and was so sweet, that 1 lb. yielded 3i. 3vi. of thick sweet extract. Without the hepatifed ammonia, in six days her urine has sunk to 6 lb. and has become bitter. Every other symptom has abated in equal proportion; so that in this case also a complete cure may be confidently expected.