think it was. It must be borne in mind that Miss R had been going regularly to school, and was in her usual health up to the 24th of March, the day she visited her friends in this city, and that it was upon this very day she drank so much water, and passed so much urine, for the first time, and that the 24th was the day following the disappearance of the symptoms which it is fair to suppose marked an unsuccessful effort of nature to establish the catamenia. On the 29th of March, I prescribed for her as before stated. The attack was a slight one, and I am now convinced that the marked prostration of strength, which was out of all proportion to the severity of the catarrhal affection, was due to the impaired nutrition resulting from the glycosuric disease.

I say I am now convinced of it; I did not realize it then. Unfortunately, her mother did not herself attach any importance to the specific symptoms, and did not therefore call my attention to them. It was not until I saw the patient again, two weeks later, that the proper diagnosis revealed itself, as it were, through the prominence of the objective symptoms. It was too late to do any good then, even if treatment would have been of any avail at an earlier period-which may be doubted. I believe that the onset of the disease was due to an abortive attempt at menstruation, marked by the symptoms above referred to; and that reflex irritation was conveyed from the congested and unrelieved ovaries and uterus, through the ganglionic nerves supplying them, to the solar plexus, the semilunar ganglion, the splanchines, and the vaso motor nerves, and, indeed to the whole sympathetic system of nerves presiding over the functions of digestion, secretion, assimulation and circulation. If this condition had been recognized at first, before the morbid impression had become fixed and titanic, so to speak, possibly something might have been done. If the local congestion, the fons et origo mali, had been relieved by local depletion or by general revulsives, arousing and diverting the energies of the ganglionic nerves into other channels, the attack might have been frustrated and nervous equilibrium re-established. If such a case presented itself to my notice again I

should certainly apply leeches to the verge of the anus, the vulva, or the os uteri. I should give Jaborandi. Jaborandi I have found very efficacious in the treatment of the attacks of spasmodic asthma, in uterine tormina and tenesmus from ovarian neuralgia, in facial and cephalic neuralgia, in arresting the paroxyisms of ague in the first stage, and in senile psoriases and prurigo, vicarious of bronchitic asthma. Jaborandi certainly possesses marvelous power over the vaso-motor nerves, and if given in time, before morbid changes had been set up either in the ganglia first attacked or in those reflexly and secondarily affected, reasoning from analogy and on physiological grounds, much benefit might be expected to result from its administration. Guided by the clue afforded by the vis medicatrix naturæ, which induces a flux from the mucous membrane of the intestine, oftentimes, when menstruation is deficient or otherwise abnormal, a sharp aloetic purge at the critical period of the menstrual molimen might tide over the difficulty. So might the Turkish vapor or hot air bath. The hypodermic use of one or two of Wyeth's tablets of morphia and atropine, if the abortive menstrual effort was attended with pain, and the skin shrunken from contracted capillaries, due to irritation of the sympathetic vaso-motor centres, would prove extremely serviceable as a palliative, if not as a curative expedient. I have assumed that the disease is of nervous origin, or, at all events, that it is through the instrumentality of the organic nerves that its baneful influence is exerted. Frequently, no doubt, it is the cerebral centre of the sympathetic from whence the morbid agency radiates to the ganglia and plexuses whose functions are to preside over so many vital processes. One case occurred in my own practice, several years ago, in which the disease was certainly traumatic, and was occasioned by the patient falling a distance of twelve feet and alighting on his heels with his body erect. He felt a dull pain in region of the ligamentum nucha, and over the lower portion of the occipital bone. He immediately became diabetic, and died in three months. But admitting the frequency of the cerebral origin of the disease from injury and morbid emotions, and possibly

hereditary transmission, that does not by any means preclude the probability of the disease originating from morbid irritation of any of the sympathetic ganglia or plexuses. I have no doubt when attention is directed in that way, and not confined too closely to looking for a cerebral origin of the malady in all cases, that future observation will prove the correctness of the assumption that in the majority of cases of death from diabetes, occurring in females at the period of puberty and of the menopause, the exciting cause will be found to consist of morbid irritation of the ovarian and uterine ganglia and plexus of organic nerves. Bartholow, in his "Practice of Medicine," calls attention to the post mortem appearances present after death from diabetes. He speaks of the "atrophy of the pancreas as of "great pathological importance," and attributes it to the "enlarged, thickened and almost cartilaginous hardness of the solar plexus, semi-lunar gangleons and splanchnincs." Evidently from the numerous lesions produced by diabetes in those tissues, glands, organs and secretions, dependent upon the integrity of the sympathetic for their physical well-being and normal physiological action, morbid irritation of the ganglionic nerves must necessarily be the chief, if not the sole factor in the production of the disease, whether that irritation arises from traumatic, emotional or systemic causes. Are not Addison's disease and progressive pernicious anæmia closely allied to diabetes? Are they not all three fatal neuroses of the sympathetic system of nerves? I owe an apology to those who have followed me this far for not having condensed my matter into a smaller compass Lack of time and a desire to impress the facts, as I viewed them, upon the minds of others must be my excuse for prolixity and tedious repetitions. The kind friend who is responsible for the paper must bear his space of odium for the infliction, if he possesses sufficient temerity to have it published without revision and curtailment.

N.B. The urine of the patient contained a great quantity of grape sugar, and its specific gravity was 1038. Delirium supervened six hours and coma three hours before death.

CLINICAL REMARKS ON A CASE OF HODGKIN'S

DISEASE.

(With a cut.)

SUMMER SESSION, MEDICAL FACULTY MCGILL COLLEGE.

By WM. OSLER, M.D., F.R.C.P., LOND.

Professor of the Institutes of Medicine in McGill University, and Physician to the Montreal General Hospital.

GENTLEMEN. The patient before you is the subject of a remarkable disease which was brought to the notice of the profession in 1832, by the late Dr. Hodgkin of Guy's Hospital. Although others had previously described cases, and Dr. Hodgkin had not himself a very clear notion of the relations of the affection, still, his paper forms the starting of our present knowledge, and the majority of English writers have, since 1865, followed Dr. Wilks' suggestion and called the disease after his name. Synonyms of it are General Lymphadenoma or― adenosis, Pseudo-Leukæmia (Cohnheim), and Adénie (Trɔusseau). The disease is characterized by a progressive enlargement of the lymph glands in certain regions, and anæmia. There may be enlargement of the spleen, and occasionally there are localized growths of lymphoid tissue in different parts of the body. The colorless blood corpuscles are not usually increased. The report of the case is as follows: R— A-, from near Belleville, Ont., was admitted to Montreal General Hospital June 6th, suffering with enlarged glands. Patient is 34 years of age; married; no children. No record of any scrofulous or tuberculous affections in his family. Had jaundice four years ago; ague two years ago; nothing special about these attacks. Otherwise has been quite healthy until present illness set in.

A year and a half ago one of the glands of the neck began to swell and rapidly increased in size; three months later another one on same side of neck began to enlarge, and still later others became involved. Axillary glands and those of groin became affected six months later than the cervical, but not to the same extent. At times he has had epistaxis and blood-spitting, and he has lately had a troublesome cough.