4. DIABETES MELLITUS.

In

A late meeting of the Westminster Medical Society was occupied with the subject of DIABETES. Dr. Ayre (to use the learned language of the Lancet) prefaced the relation of a case with a Peroration," which we would call an exordium, on the pathology of the disease. The Doctor did not agree with Heberden, that it was a breaking up of the constitution in advanced life-nor with Cullen, that it was nearly always fatal-nor with those who considered it to be dependent on a faulty digestion,-an imperfect assimilation, or a bad sanguification. short, he looked upon diabetes to be a local disease or disorder of the kidneys the nature of which, he thought, was chronic inflammation. Entertaining this view, he therefore expected but little from any peculiar diet tending to prevent the formation of saccharine matter in the fluids, and its elimination by the kidneys. Local detractions of blood from the loins formed almost the whole of his therapeutics. He stated the details of a case, part of which had been drawn up by the patient himself, from which it appeared that the quantity of diabetic urine amounted, at one time, to more than 20 pints per diem, while the thirst was unquenchable, and the appetite voracious. The plan of treatment above mentioned was put in force, and by the time the patient had been seven times cupped on the loins, the disease was subdued (or supposed to be so) and the health restored. Unfortunately for the efficacy of this plan, Dr. Barry informed the society that the same patient had come under his care, shortly after he left Dr. Ayre, and the diabetes had returned nearly as bad as before. Dr. Barry had put the gentleman on Rollo's plan of animal food diet, and to this the disease was once more giving way.* A sharp discussion now took place respecting the chemical pathology of diabetes-Dr. Barry maintaining that the grand source of the malady would be found in the fluids, while Dr. Ayre, Mr. North, and some others, considered the solids in fault. Mr. North brought forward the

in

authority of Berzelius to prove that, certain affections of the liver, the urea disappears from the urine, and a saccharine principle is there evolved-in short, diabetes produced.

Dr. Johnson was inclined to agree with Dr. Barry, that the patology of diabetes could not be affixed on any one particu lar organ-neither the kidneys, the liver, the stomach, or the lungs, exclusively. In all the severe cases which he had seen, however, there was some evident functional disorder of the system accompanying the diabetes. In every case where he had an opportunity of examining or seeing examined, the body after death, the lungs were found affected with disease, whatever were the appearances in other organs. In some researches which he made among the most authentic dissections that have been recorded of this disease, he found that, in very few instances indeed, were the lungs in a state of integrity. By this he did not mean to infer that disease of the lungs was the cause of diabetes; but he thought that this fact authorised us to suspect a considerable connexion between disordered function in the respiratory ap paratus, and the production of diabetic urine. In respect to treatment, he had found restriction to animal diet, with occasional blood-letting, and great attention to the improvement of such functions as appeared to be deranged, the most suc cessful plan. The general sense of the Society appeared to be in favour of the mode of treatment recommended by Rollo. Dr. Ayre adhered to his opinion, that the depletive plan of Watt, was superior-and especially local depletion, from the neighbourhood of the kidneys. It appeared, indeed, that, in the case detailed by Dr. Ayre, even admitting that the result was not conclusive, the cupping on the loins always gave temporary relief. This the patient himself acknowledged to Dr. Barry, though he got tired, he said, of the plan, as the relief was

transient.

5. SURGICAL CURRICULUM.

In our last Fasciculus we intimated our intention of examining seriatim, the dif ferent items in the recent curriculum of

4. DIABETES MELLITUS.

A late meeting of the Westminster Medical Society was occupied with the subject of DIABETES. Dr. Ayre (to use the learned language of the Lancet) prefaced the relation of a case with a Peroration," which we would call an exordium, on the pathology of the disease. The Doctor did not agree with Heberden, that it was a breaking up of the constitution in advanced life-nor with Cullen, that it was nearly always fatal-nor with those who considered it to be dependent on a faulty digestion, an imperfect assimilation, or a bad sanguification. In short, he looked upon diabetes to be a local disease or disorder of the kidneys the nature of which, he thought, was chronic inflammation. Entertaining this view, he therefore expected but little from any peculiar diet tending to prevent the formation of saccharine matter in the fluids, and its elimination by the kidneys. Local detractions of blood from the loins formed almost the whole of his therapeutics. He stated the details of a case, part of which had been drawn up by the patient himself, from which it appeared that the quantity of diabetic urine amounted, at one time, to more than 20 pints per diem, while the thirst was unquenchable, and the appetite voracious. The plan of treatment abovementioned was put in force, and by the time the patient had been seven times cupped on the loins, the disease was subdued (or supposed to be so) and the health restored. Unfortunately for the efficacy of this plan, Dr. Barry informed the society that the same patient had come under his care, shortly after he left Dr. Ayre, and the diabetes had returned nearly as bad as before. Dr. Barry had put the gentleman on Rollo's plan of animal food diet, and to this the disease was once more giving way.* A sharp discussion now took place respecting the chemical pathology of diabetes-Dr. Barry maintaining that the grand source of the malady would be found in the fluids, while Dr. Ayre, Mr. North, and some others, considered the solids in fault. Mr. North brought forward the

authority of Berzelius to prove that, in certain affections of the liver, the urea disappears from the urine, and a saccharine principle is there evolved-in short, diabetes produced.

Dr. Johnson was inclined to agree with Dr. Barry, that the patology of diabetes could not be affixed on any one particular organ-neither the kidneys, the liver, the stomach, or the lungs, exclusively. In all the severe cases which he had seen, however, there was some evident functional disorder of the system accompanying the diabetes. In every case where he had an opportunity of examining or seeing examined, the body after death, the lungs were found affected with disease, whatever were the appearances in other organs. In some researches which he made among the most authentic dissections that have been recorded of this disease, he found that, in very few instances indeed, were the lungs in a state of integrity. By this he did not mean to infer that disease of the lungs was the cause of diabetes; but he thought that this fact authorised us to suspect

considerable connexion between disordered function in the respiratory apparatus, and the production of diabetic urine. In respect to treatment, he had found restriction to animal diet, with occasional blood-letting, and great attention to the improvement of such functions as appeared to be deranged, the most suc cessful plan. The general sense of the Society appeared to be in favour of the mode of treatment recommended by Rollo. Dr. Ayre adhered to his opinion, that the depletive plan of Watt, was superior-and especially local depletion, from the neighbourhood of the kidneys. It appeared, indeed, that, in the case detailed by Dr. Ayre, even admitting that the result was not conclusive, the cupping on the loins always gave temporary relief. This the patient himself acknowledged to Dr. Barry, though he got tired, he said, of the plan, as the relief was transient.

5. SURGICAL CURRICULUM.

factorily explained.-Ed.

ferent items in the recent curriculum of

the College of Surgeons. Entertaining, as we do, the greatest respect, and even friendship, for several individual members of the Council, and knowing that many of them are anxious to do every thing that is liberal and conducive to the public good, we cannot but hope that the observations of those who must be disinterested on the subject will be taken in good part, and not attributed to sinister motives, or a disposition to hypercritical censure. In our remarks, we shall appeal entirely to the judgment, and not to the prejudices, of all concerned. In the present instance, we shall limit our inquiry to the first clause of the curriculum.

We should have thought that the liberal opinions lately introduced by many-indeed we might say by all, the most talented and elightened men of the age, in respect to free trade and international reciprocities of interest, would have operated on the minds of men of science and literature, and that they would not have enlisted themselves on the side of ignorance, narrow-minded policy, JohnBull prejudice, and downright opposition to the advancement of that science and literature, of which they are, at once, the guardians and the ornaments. And, of all branches of human knowledge, that of medicine and surgery should surely be the most entirely emancipated from local, or even national restrictions, seeing that it is the same in kind, or every point of this great globe which we inhabit. We have no objection to that patriotism which aims at raising the character and acquirements of one nation over those of other nations. This is laudable, and tends to useful emulation among all. But we most decidedly object to that principle which limits or impedes the means of acquiring that knowledge which raises the character of individuals, and consequently of nations. What would be thought of the Russian Autocrat, if he threw every kind of impediment in the way of his naval, military, and medical subjects, who sought to improve themselves in ship-building, military discipline, and the practice of physic and sur

gery, by sojourning in Paris, London, or Vienna ? We would call him a Goth, a Tartar, or a Vandal! But he has not permitted us to accuse him of such barbarism. He has encouraged every individual exertion of this kind-not only by withdrawing every obstruction, but by holding out positive rewards. Yet we consider all medical knowledge as limited to the soil of Britain-and instead of fostering the praiseworthy endeavours of individuals to draw professional lore from every spot where it can be procured, we issue our little injunctions against all science that is not taught on half a dozen points or dots on the surface of the British Isles! How is this reconcileable with sound sense? How does it quadrate with a maxim as old or older than the Christian æra fas est et ab hoste doceri." When we reflect on the liberality, the enlightened policy of the great medical schools of Europe, where English study is allowed to form part of the curriculum, we blush for the institutions of our own country, which enact statutes that would do no credit to the intellects of a Cossack, an Otaheitian, or Canadian! We know, indeed, that there are men, connected with our chartered bodies, who have the effrontery to stand up, even in our medical societies, and whine forth, with methodistical cadences, their little interested orations about the excellence of medical jurisprudence in this country, and the complete superiority of British pathology over that of every other people in Europe. They are aware that this flattering unction will gain the smile of the moment, from those who are engaged in the same line of policy as themselves; but, as long as our hand can wield the pen, we will bring this "mentis gratissimus error," before the bar of public reason, for adjudication.

What is the collegiate excuse for this restriction of anatomical and pathological study to certain schools in this country? The old corn-law policy. Favour the English farmer. Protect the farmers of anatomy and surgery in Guy's and Bartholomew's, although the consumers, the students, may pay twelve or fifteen guineas for each body, and consequently may be half-starved during each season! But why do the anatomical farmers import their wine from the Bordelais, when grapes are seen mantling on the walls of their

country-houses! Because the vine grows plentifully in the fields there, and can only be trained on the sunny sides of their houses here. It is the same with anatomy. The dear and scanty supply in our dissecting rooms must be put up with, and preferred to, the cheap and plentiful supply in Paris-and all this for the encouragement of the British anatomical farmer! The illiberality of this policy is undeniable, and what are the advantages, after all, which the monopolists can hope to gain by it? There is not one in one hundred of English students who has the means of travelling to other countries for anatomical, pathological, or clinical improvement. Yet to deter this one in two or three hundred, from prosecuting a portion of his studies in those places which are peculiarly favourable, the council of the College has enacted a law which must be viewed by every enlightened man in Europe as a libel on the English profession! The sting of this libel, too, is rendered the more galling, when we see such a place as Aberdeen "recognized,' while Paris is "incognizable !" Was it possible that the members of the Council could preserve their gravity when they put their seal to this primary and fundamental law? What reason has been assigned for giving the prerogative to Aberdeen, in preference to twenty other and better places? Because, forsooth, there is an anatomical CHAIR in Aberdeen ! Why so there is in Oxford and Cambridge, and yet we do not see these "venerable seats of learning,' recognized by the College. Now anatomy and pathology may be taught by a chair or by any other wooden machine-but it can only be learnt by dissection. Dissection cannot be performed without bodies -and bodies cannot be procured, except where there is an abundant population and consequent mortality. If these be axioms, and we believe they are, the statute which recognizes Aberdeen, as a school of anatomy and physiology, and rejects Manchester, Liverpool, and other great provincial cities and towns, where hospitals abound, bodies can be procured, and excellent anatomists reside-is a blot on the justice and common sense of the country. The sooner the College revise and amend this first item in their curriculum, the better. It would be only decency as well as liberality to admit one year, at least, of Parisian or other continental time in the curriculum-it would

be good policy, inasmuch as it would hold out some little encouragement for young men to extend their knowledge and expand their minds, by visiting the institutions of foreign countries, where clinical practice is open to strangers, and anatomy can be prosecuted at a very trifling expense, instead of binding them down to study anatomy, where dissection is either impracticable for want of subjects, or ruinous by the expense of them. So much for the first count in the indictment. We shall discuss the other counts in succeeding fasciculi of this Journal.

6. INGUINAL ANEURISM-EXTERNAL ILIAC ARTERY TIED. By MR. BRODie.

It is well known how very successful the operation of tying the external iliac has proved in the hands of surgeons, both in this country and abroad. It is to Mr. Abernethy that we are indebted for it, and really the history of the successive attempts made by that gentleman reflects the highest credit upon his firmness and abilities. At the time Mr. Hodgson's valuable Treatise on Aneurism was first published, namely, in 1815, twenty-two cases had occurred, of which fifteen had proved successful. Since that period the operation has been frequently repeated, and, upon the whole, with great success, so much indeed, that it has been proposed to have recourse to it in popliteal aneurism, a plan which is not very likely to be put in practice, or, if put in prac tice, to be of service.

The subject of the present case, which we had an opportunity of witnessing, and shall detail very briefly, was a tailor, æt. 38, who had been exposed to damp and cold in White-Cross Prison, and had suffered a great deal of anxiety on account of his family. In November last, whilst having connexion with his wife, he felt as if something had given way in the left groin, and soon afterwards noticed a small throbbing tumour in the part. It increased gradually for a fortnight, then remained stationary until the latter end of January, when it again began to swell, and the limb became edematous. When admitted into St. George's, February