196 ROYAL MEDICAL AND CI-IIRURGICAL SOCIETY: ON INTERMITTING DIABETES.

by the profession to be an insult which could no longer betolerated. Although the quacks had been repudiated by theProvincial Medical and Surgical Association, which really andtruly uttered the voice of the profession, the compilers of the" London and Provincial Medical Directory" contumaciouslyadhered to the obnoxious course of proceeding that they hadpreviously pursued. All possible honours were again bestowedupon the quacks in the columns of a Guide that contained thenames and titles of the most distinguished members of our

profession. This abominable proceeding produced a loud andgeneral demand for another Medical Directory that shouldbe altogether free from such detestable defilements; and, at amost opportune period, the Editors of the BRITISH MEDICALDIRECTORY, influenced by a spirit and motives which reflecton them the highest honour, produced the valuable andsuccessful work which is now iu the hands of the profession.The tabular forms issued by the Editors of THE BRITISH

MEDICAL DIRECTORY, with a view to the compilation of thiswork for 1854, will be found in the current number of thisJournal. The promptitude with which the "returns" weremade last year, and the obvious obligation that exists for

replying with despatch to the request of the Editors, renderany exhortation from us altogether unnecessary. It will beseen that the pages which contain the tabular forms are not

numbered; and that they can be removed without detriment Ifrom the body of the Journal which contains them. Next to

the exertions of the Editors themselves, the extraordinarysuccess of THE BRITISH MEDICAL DIRECTORY is due to the able

and energetic aid which that work has received from membersof the medical profession in all parts of the kingdom.

Medical Societies.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, JUNE 28, 1853.—DR. COPLAND, PRESIDENT.

ON INTERMITTING DIABETES, AND ON THE DIABETES OF OLDAGE. By H. B. JONES, F.R.S.

The author’s object in this communication was to point out somephenomena connected with diabetes, which he had not foundmentioned by other writers. Preliminary to the record of thecases, the author offered some observations on the incorrectresults obtained by calculating the amount of sugar present inthe urine from the specific gravity. If diabetic urines weresolutions of nothing but sugar in distilled water, the tables by Dr.Henry, and the amount of sugar calculated from the specificgravity, would give all the information required; but a multitudeof other substances were present besides sugar, each of whichwas variable, and each of which might cause the specific gravityto vary, whilst’the quantity of sugar might remain constant. Tobe accurate, therefore, the amount of sugar should always be de-termined by direct experiment, and never calculated from thespecific gravity. Results were given, exhibiting the specificgravity, the amount of sugar calculated from solid apparatus, andthe absolute amount of sugar obtained by direct analysis. Onthe subject of intermitting diabetes, the author observed thatthere could be little doubt that our knowledge of the nature ofthis disorder might be extended by means of accurate determina-tion of the varieties in the amount of sugar in the urine passed atdifferent periods of the day, and under different circumstances.His object in relation to this form of the disease was to recordsome cases in which, either from the medical treatment, or theregimen, or the natural course of the complaint, the variation inthe amount of sugar was not from much to little, but from highlysaccharine urine to total absence of sugar. The state of thenrine a few hours after the sugar had disappeared, and an hour ortwo before it re-appeared, was most especially worthy of atten-tion, inasmuch as it might lead to a truer knowledge of the stateof the system which preceded the commencement of diabetes. In

j intermitting diabetes the disease might be seen beginning and. ending, and the explanation of the state of the urine which pre--

ceded the appearance of the sugar and followed its disappearance,I must be included in the true theory of diabetes. Moreover, aj better knowledge of the antecedent phenomena might enable us

to ward off the disease, if not to treat it with more success. Ther

records of seven cases of the intermitting form of the diseaseI were given, and very minute particulars in several, illustrated[ the amount of sugar present in the urine at stated intervals in

the twenty-four hours, as well as the influence of particular forms’ of diet on the proportion of sugar excreted. In these cases the’ state of the urine just after the sugar had disappeared was worthy

of attention. A remarkable excess of urea was constantly foundbefore and after the sugar disappeared; and although this mightbe attributed to the animal diet, yet the occurrence of free uricacid and oxalate of lime in the urine pointed most clearly to astate of indigestion which was every day to be found without any

’

sugar appearing in the urine. The author offered the followingtheoretical contrast between ordinary and saccharine indigestion:Ordinary indigestion showed itself in a want of action on thesugar and starch taken as food, in consequence of which excessiveacidity was produced-that is, the changes in the non-nitrogenousfood were imperfect. Imperfect changes also occurred in the

nitrogenous food; this was made evident by an excess ofurates and urea in the urine, and perhaps also by the for-mation of oxalate of lime. In diabetic indigestion the effectmight be traced also on the two great classes of food. At firstfrom the non-nitrogenous food sugar was formed instead of acid.Ultimately, if not simultaneously, sometimes the arrest ofhealthy changes extended to the albuminous food, and, instead ofan excess of urates and urea, other products were formed, one ofwhich was sugar. It was possible that some of these productsmight be found in the urine. Possibly benzoic acid, which ispresent in some cases of diabetes, in variable quantities, might beone of the new products. Whether this theory were true or notit was of practical importance to remark the tendency to

acidity in these cases of intermitting diabetes. In such casesanimal diet alone or with alkalies might stop the formation ofsugar. It followed also that when oxalate of lime, uric acid,and excess of urea were found in the urine, it was probable thatthe diabetes might be temporarily, if not permanently, removed.The occurrence or absence of these substances in the urine mightlead to the recognition of the stage of the disease, and they mightthus guide us in our prognosis and treatment. The second partof the communication related to the frequency of diabetes in oldage. Reference is made to a paper, by M. Dechambre, on thissubject, who concluded, from observations made on the urine ofold people at the Salpetriere, that sugar was habitually presentin the urine of old people. The author gave the particulars ofnine cases of diabetes in elderly people, and thought that theoccurrence of this affection at the latter periods of life pointedalso to the theory of diabetes as an indigestion resulting from anarrest of healthy changes in the food. The cases mentioned inthis communication were, in the opinion of the author, opposedto the view of diabetes depending upon an affection of thenerves, or of the liver; and his daily observation led himrather to the view taken by Dr. Prout, that diabetes was anindigestion, and that it first affected the non-nitrogenous, andafterwards the nitrogenous constituents of our food. Asregarded treatment, whatever was beneficial for excessiveacidity, was found equally serviceable in diabetes. Alkalieswere used in all the cases with benefit. Small meals, free fromsugar and acid, and the substances that could give rise to sugarand acids, constituted the best diet. He found also that vege-table acids with alkalies were occasionally useful. In a foot-notethe author mentioned some experiments he had not yetpublished, determining the quantity of sugar in several kinds ofbeer and wine. Porter contained from 27 to 57 grains of sugarin each ounce of liquid; ale from 43 to 50 grains ; beer 25 to40 grains ; port-wine 8’5 to 11 grains ; sherry 2 to 4’7 grains;claret none. The absence of all sugar, and the presence oflittle alcohol. caused claret to taste highly acid, whilst the quan-tity absolutely present was not more, sometimes less, than in otherwines which have no acid taste, as, for example, most port-wine.

AN ACCOUNT OF A DISSECTION OF AN OVARIAN CYST VFHICHCONTAINED BRAIN. By HENRY GRAY, Esq., F.R.S.

THE attention of morbid anatomists had been directed formany years to the structure of ovarian cysts and their contents,and especially to those which apparently contained ieetal remains,with a view, if possible, of determining their origin and mode ofgrowth. It was the doubts that still hung over this subject,that induced the author to believe that the present case might

197prove of interest, and that at some future time it might aid inexplaining the law that governed the singular development andmode of growth of these tumours. The patient was a female,aged twenty-eight, who died in St. George’s Hospital of typhusfever. A full record of the post-mortem appearances was given,but the contents of the pelvis relate more especially to the presentsubject. The vagina was healthy; the uterus was somewhatlarger than natural, and its muscular wall thickened. The mem-brane lining its cavity was covered throughout its entire extentwith a highly vascular villous membrane, resembling the decidua.The round ligaments were both healthy ; the right Fallopiantube more dilatable than natural, and contained a thin bloodyfluid; the right ovary was healthy; the left Fallopian tube washealthy. The left ovary was occupied as a large cyst, the sizeof an orange ; the lining membrane of the interior of the cystwas vascular; its wall was composed of an external peritonseallayer, an inner, smooth, shining coat, devoid of epithelium. The

cavity of the cyst contained a few short, light-brown hairs. Thelower half of the tumour consisted of a second cyst, containingsome yellowish, white, purulent-looking fluid, with some granularfatty matter of the consistence of honey, scaly epithelium andfine hairs of a brownish colour being intermixed with it. The

fatty matter was found to be fluid at less than the natural tem-perature of the body. The hair, on being separated from thematter, was found to be attached to the wall of the cyst by distinctbulbs. A portion of the wall at the lower part of the cyst pre-sented an appearance similar to the surface of the scalp; therewas a thick layer of scaly epithelium mixed with fat covering thesurface; numerous sebaceous glands were indented into this layer,and a canine tooth projected from the skin, fully formed ; it was

implanted into a fragment of bone, covered with periosteum.There was a third cyst situated near the fragment of bone, aboutthe size of a walnut, the wall of which was delicately vascular,forming meshes resembling the pia mater; the contents of thiscyst presented all the characters of brain. On microscopic ex-amination, the ordinary elements of nervous matter were seen,consisting of varicose nerve tubules, intermixed with the elemen-tary component parts of gray matter; nuclei, and nucleatedvesicles containing granules. There was also a fifth cyst, thecontents of which were much less like brain matter than the con-tiguous one. So far as the author had been able to ascertain,he believed that nervous matter had not been previously describedas forming a portion of the contents of these ovarian cysts.

TWENTY-FIRST ANNIVERSARY MEETING OFTHE PROVINCIAL MEDICAL AND SURGICALASSOCIATION.

IT had been our intention to publish a lengthened account ofthe proceedings of the above Association, but on perusing ourreport we found so little that was generally interesting, thatwe have thought it necessary to publish only the followingsummary. The Medical Reform resolution was inserted lastweek.The meeting was held at Swansea on the 10th and llth of

August, Dr. Gwynne Bird in the chair. The President havingbriefly addressed the meeting, the Report of the Council ofthe Association was read. It stated that there had been aconsiderable increase in the number of members since the lastmeeting, and that a metropolitan branch of the Associationhad been formed. With regard to the financial condition ofthe Association, the subject of the journal was first mentioned.From this it appears that from the increased expense entailed z,on the Association by the publication of a weekly journal, theTransactions for the future would in all probability not becontinued." The gross expense of the journal for the last sixmonths had been .E1327 Is. 4d., .E828 14s. 6d. of this beingcontributed from the subscriptions of members. The subjectof Medical Reform was then entered upon, and shown to beprogressing very favourably. The Benevolent Fund had greatcalls upon its resources, but members were urged to contributeto it. The Report was adopted. The Report of the JournalCommittee was then read, and after some discussion receivedand adopted. A vote of thanks was then proposed to Dr.Ogle, the President of the past year, and carried unanimously.Dr. Ogle returned thanks. Some conversation followed re-specting the disagreement between Mr. Syme and Mr. Hester,which ended eventually in the following resolution being pro-posed and carried:"That the Association regrets that thereshould be any misunderstanding between Mr. Syme and Mr.Hester; but that- the Association does not hold itself re-

sponsible for the sentiments expressed in the papers which

may be published in the Transactions, and recommended fat"publication on account of their general merits." The Addresson Surgery was then delivered by Mr. Augustin Prichard, ofBristol. A conversazione took place in the evening at theNational School Rooms.The proceedings on Thursday commenced with a public <

breakfast at the Mackworth Arms. Dr. Charles RadcliffeHall then delivered the Address on Medicine. It was thenarranged that the next Anniversary Meeting should be heldat Manchester, and that Mr. W. J. Wilson should be Presidentelect. Dr. Radford was appointed to deliver the Address inMidwifery, and Dr. Conolly the Address in Medicine. Severalpapers were then read. About 100 members dined togetherafterwards at the Assembly Rooms.

Correspondence.

DR. AYRE ON MALIGNANT CHOLERA.

"Andi alteram partem."

To the Editor of THE LANCET.

SiR,-The threatened return to this country of the malignantcholera, and the still questionable state of public opinion in refer-ence to its appropriate treatment, will be accepted, I trust, as myapology for the application which I am about to make to myprofessional brethren to favour me with communications on theresults of that particular mode of treatment which, as its authorand earnest advocate, has become in some manner associatedwith my name, and which consists in the giving of one or twograins of calomel every ten or fifteen minutes during the wholeperiod of the stage of collapse, and still smaller doses, and at stillwider intervals, in its premonitory stage of diarrhoea, with thetenth or twelfth of a grain of opium with each pill, as the circnm-.stances of the case may require.

In the reports which I would be here considered as emphaticallysoliciting, I wish to have comprised the following particulars:-

1st. The degree and previous duration of the collapse whenthe treatment began.

2ndly. The dose of the calomel, the times of its repetition, andthe whole quantity taken.

3,rdly. What auxiliary means were used along with it.4thly. What the result in a given number of cases; and where

the issue was unfavourable in any particular case, what were thecircumstances which appeared to produce it.

In making the foregoing application to my professional friends,I fear that I may be thought to have trespassed unduly on theirindulgence, and I must therefore entreat them to remember howmuch that is important to society is involved in the whole questionof the mode of treating this disease. The hope, indeed, has longbeen cherished by me, that the Board of Health, in connexionwith its other useful labours, would ere this have applied itselfto this subject. This, however, is still unattempted; and it isin the absence of such an inquiry, and, to a limited extent, incorrection of it, that I have made this appeal in relation to themethod pursued by me in its treatment. Should my appeal beresponded to, I can fearlessly commit myself to the declarationthat the result will confirm all that I and others have asserted ofits success, and that the report which I shall thence be enabledto make will, as I devoutly believe, set the question of the value

of the calomel treatment at rest for ever.*I am, Sir, your obedient servant,

Hull, August, 1853. _______________JOSEPH AYRE, M.D.JOSEPH AYRE, M.D.

GRATUITOUS ADVICE.To the Editor of THE LANCET.

SxR,-The system of gratuitous advice, so ably exposed byyourself and correspondents, is, indeed, an evil of the first

magnitude to the character and interests of the profession.That the labourer is worthy of his hire, and that charity should

’ - The following extract from a letter from the United States, addressedto THE LANCET, and printed in that journal in February, 1850, will serveto show the extent to which the treatment by calomel was followed, andthe vast success which resulted from it :-

" In twenty cases," says Dr. Kelso, " of average severity, occurring inmy practice, calomel, singly, or in combination with acetate of morphine,as the exigency of the case demanded, proved a mine of almost unfailingsuccess. That similar results followed the labours of many of my profes-sional brethren who pursued this course in Iowa, Illinois, and Wisconsin,is undoubted ; and I take pleasure, indeed, in recording the fact, that morethan three-fourths of the active practitioners in those states, and, indeed,of the union, followed the system of Dr. Ayre, or a practice very closelyallied to it, with very general success."-Extracted from a Letter by J. S.KUL$0, Esq., M.D., of Oak Springs, Wisanses, United States.