fined, so that she did not require to go to the closet oftener than once in four or five days. The evacuations possessed their natural colour. She had some uneasiness on pressure over the epigastrium.The margin of the liver could be felt below the cartilages of the ribs, and appeared slightly enlarged: some pain was caused by pressure over this organ. The urine was not high coloured, and formed no precipitate on the addition of nitric acid. She had now very little uneasiness in the chest; no cough, palpitation, or headache. Neither by auscultation nor by percussion could any thing abnormal be detected in the lungs or heart. Some slight remedies were made use of. In about a week she became feverish and generally ill, without any known cause: in the evening of the same day she vomited some bile. The vomiting continued next day, and was accompanied by loss of appetite, and severe pain at the pit of the stomach. The pulse was 100, small and feeble. The vomiting was almost incessant for the two following days, when she became extremely exhausted: the pain in the epigastrium was most severe. No evacuation from the bowels had taken place since the commencement of the attack. Tongue dry, furred, white on the dorsum, red at the tip. Pulse 90, small. She died exhausted the same evening. The liver was found rather larger than natural; its right lobe firm in texture, and of a peculiar greyish green colour throughout. About two ounces of dark green bile were contained in the gall-bladder. The glands in the neighbourhood of the stomach were enlarged, softened, and infiltrated with a blackish matter. Those near the pancreas were also enlarged, and filled with tuberculous matter. The pancreas was about natural in size. Within its last half, or tail, was found an abscess, capable of holding a small hen's egg. It was filled with thick purulent matter, and its cavity was lined by a thick and tough, greyish, organised membrane, within and around which. were numerous softened tubercles. External to the abscess the tissue of the pancreas was spread out, and appeared atrophied. The right half of the pancreas was dark coloured, but healthy in structure. The pancreatic duct was entire. Two small cretaceous masses of tubercles were found in the spleen, and two similar ones in the apex of the left lung. Traces of recent violent inflammation were found in the stomach, the duodenum, and for a short way down the jejunum.-Ibid. from Gaz. des Hôpitaux. MANCHESTER PATHOLOGICAL SOCIETY. Detection of Sugar in the Expectoration of Patients affected with Diabetes.-Dr. Francis presented to the Society a specimen of sugar which he had obtained, a few days previously, from the expectoration of a man the subject of diabetes mellitus. The patient, aged 25, for upwards of a year suffering the ordinary symptoms of this disease, and at present much wasted in flesh, had, during the last six months, shown signs of advancing pulmonary phthisis. The expectoration latterly had amounted to little less than 24 ounces daily, and, on the day which furnished the specimen submitted to examination, had even exceeded that quantity. It was composed of an abundant white, frothy, tenacious mucus, holding in suspension little rounded masses of opaque yellow material. In order to the detection of sugar, the expectoration was, first of all, treated freely with strong alcohol, which coagulated much of the albuminous matters. Distilled water was then added, and, after agitation and digestion for a short time, the whole was thrown upon a filter, and a clear watery fluid readily passed through. A small portion of this fluid reduced the protoxide of copper when tested after the manner recommended by Trommer, and another portion underwent fermentation over mercury. The remainder was evaporated in a water-bath to dryness, the residue broken up into fragments, and digested for several hours in alcohol, which was then filtered. The alcoholic solution thus obtained was of a yellowish tint, clear, and decidedly sweet to the taste. On evaporation, it left the considerable quantity of sugar now produced to the Society, and which will be found partly crystalline, of a rich sienna brown colour, strong honey-like odour, and intensely sweet taste. A fluid ounce of the expectoration, after dilution with water, yielded by fermentation a trifle more than 2 cubic inches of carbonic acid, which would be equivalent to 24 grains of sugar, or 50 grains to the imperial pint. The urine passed at the time of the examination contained sugar; its specific gravity was 1032, and its average standard for some days has been about 1035. The quantity passed was much less than formerly. Dr. Francis had detailed at length the account of the process he had used, because, so far as he knew, the presence of sugar in the expectoration of diabetes had not previously been sought; at any rate, he could find no allusion to the subject in the Sydenham Society's edition of Simon's Animal Chemistry, which, with the notes of its accomplished editor, may be assumed to have brought our knowledge in such matters up to the present time. In addition to the above case, he had, within the last two days, had the opportunity of examining the expectoration of another man who was under treatment two years ago with diabetes, and who, in addition to this, is now far advanced in phthisis. Here the expectoration was more scanty, and consisted of purulent matter, rendered tenacious by an admixture of rust-coloured secretion from a little local pneumonia. In this case an ounce of sputa contained so much as about seven grains of sugar. It might be found, he thought, when closer attention came to be given to the subject, that there were other organs than the kidneys habitually playing an active part in the removal of the sugar which was accumulating in the blood during the progress of diabetes. There were, at least, some grounds for believing such might be the case from the results just detailed, and, if so, the quantity of sugar escaping in the urine could not be viewed as an absolutely safe index to the quantity formed in the system, unless taken in conjunction with other means of its elimination. The cases might further be looked upon as furnishing an argument, if further evidence upon the subject were necessary, that the kidneys play no part in the formation, but merely in the separation from the blood, of the sugar. Raspberry-like Nævus.-Mr. Thompson, of Stalybridge, presented four nævi, removed by ligature, which were interesting by reason of the proof they afforded of their hereditary character. One was larger than a walnut, and three equalled raspberries in form and size. In colour they were bright blood red, and their surfaces resembled exactly the raspberry in appearance. very healthy She first nothen like an After a time They were removed from the right shoulder of a woman, aged 44 years, who had borne eight children. ticed the large nævus in her eighteenth year. It was ordinary brown mole, possessing very little sensibility. it increased in size, and at length became very sensitive and painful, and acquired the appearance described. It was attached to the skin by a peduncle about a quarter of an inch in diameter, which was occasionally excoriated, and discharged a very offensive fluid. This woman's daughter, maternal grandmother, and great grandfather, have all had similar nævi.—Ibid. Considerations on the Treatment of Typhoid Fever. By M. GENDRIN.-Typhoid Fever,--the dothinenteritis of Bretonneau, and typhus abdominalis of the Germans, has lately become unusually common in Edinburg. It may be said to be the prevailing form fever of both in that city and in Glasgow, a circumstance sufficiently curious, when it is remembered that, for several years past, no intestinal lesion has accompanied the disease. It was first remarked by Prof. John Reid, when pathologist to the Edinburgh infirmary, that the few cases which appeared there, always came from the country, more especially from Linlithgow, or Fife, and never originated in the city. Dr. Hughes Bennett, the present pathologist, has, for more than three years, had occasion to confirm the truth of this observation, and lately stated (see report of Ed. Medico-Chir. Society, Month. Journ., June, 1846), that during that time, only two cases had occurred in the infirmary. During the present winter, the disease has been very common, and he has examined upwards of twenty cases, in which the follicular lesion of the intestines has been more or less well marked. Under these circumstances, observations on the treatment of this affection, by so experienced a physician as M. Gendrin, condensed from a lecture he lately delivered, may be considered as particularly well timed. According to M. Gendrin, typhoid fever must inevitably pass through its three stages of increase, intensity and decline. He insists on this, because the practical rules which result from it, are, that the disease cannot be cut short, that the expectant system is the basis of our treatment, and that the active interference of art ought to be limited to accelerating the evolution of the disease, and to moderating the accidents which arise during its course. Thus, in a slight case of typhoid fever, M. Gendrin only follows the expectant system of medicine. He causes it to consist in surrounding the patients with all the hygienic precautions compatible with their social position: submitting them to a dietetic regimen having relation to the state of their digestive organs, and removing all those moral influences which may act injuriously upon their minds or bodies. In this manner a cure is effected in a considerable number of cases. When the disease is severe, a more active treatment is necessary, consisting of blood-letting, evacuants, baths, epispastics, alteratives, &c. M. Gendrin believes it useful to practise one or two bleedings from the arm in the first stage; but when this has passed, when the petechial eruption is developed, he considers no benefit is to be thus obtained. Local blood-letting, according to him, causes more injury than benefit, for leeches or cupping applied to the abdomen, act at too great a distance from the inflamed intestine, to render them efficacious and, on the other hand, a quantity of arterial blood is removed, which enfeebles the patient without doing any good. : In many cases, dyspeptic symptoms may be observed at the commencement, or during the progress of the first stage. All the individuals who enter his wards with stomach symptoms take an emetic with the best results. Typhoid fevers, accompanied at their commencement with symptoms of prostration, are transformed into a benign fever, under the influence of a vomit. Such was the treatment the French found to succeed completely at Vienna in 1809. It is only necessary that the emetic should be administered at an early period, for when the petechial eruption has occurred, and ulcerations have taken place in the small intestines, or an erythematous state in the stomach, the remedy is more hurtful than beneficial. M. Gendrin strongly condemns the indiscriminate use of purgatives, more especially drastic ones, which he rejects altogether. The only agents of this class he employs are gentle aperients, emeto-cathartics, which, in addition to a local, conjoin a general action. He prescribes these remedies at the commencement, and sometimes during the decline of the disease, when there remains some flatulence, and liquid matters remain in the intestines, as is announced by gurgling. A saline purgative will then excite the action of the intestines, and decide the convalescence. M. Gendrin has employed cold affusion in typhoid fever for fifteen years, causing water to trickle over the surface, or to be applied with a sponge. He considers it most afficacious in moderating the symptoms of the first stage, and it is very grateful to the patient. The subtraction of caloric in this way causes the pulse to fall from 120 to 80 and even to 60 beats in the minute. It sometimes happens that the pulse very slowly rises again, and therefore it is necessary to proportion the subtraction of caloric to the reactive powers of the individual. It should only be applied in the first stage, for after the eruption, reaction is not possible. Tepid baths, on the other hand, are applicable exclusively to the adynamic period. They then serve to re-establish the action of the skin. It is necessary to prevent their too prolonged use, and too high temperature, otherwise they become debilitating. Epispastics, more especially blisters, are at present very little employed. In the last stage tonics are often necessary, especially combined with nutritive substances. M. Gendrin gives, with beef tea (bouillon), the wine of quinine; which has the advantage of uniting a fixed tonic with a diffusible stimulus. Wine, associated with bitter and aromatic substances, he prefers to camphor, which is only useful when there are ataxic symptoms. Lastly, M. Gendrin speaks of the medicines which act chemically. They are, Seltzer water, chloride of sodium, alkalies, and chlorine, administered internally. All these preparations, according to the Professor of la Pitié, have no great advantages to recommend them. The effervescing lemonade only constitutes an agreeable drink, the action of which, slightly stimulating, may be rendered serviceable. With regard to the chlorates and chlorurets, they have such an insupportable odour, as to be rejected for this cause alone, even were their therapeutic inutility not proved by experience.-Monthly Journal of Medical Science, from Journal de Medicine et de Chirurgie Pratiques. Case of Pulsating Veins. By SIR H. MARSH, Bart.-Catherine Duffy, aged 28, was admitted into Steevens' Hospital under Sir Henry Marsh, 13th May, 1846, presenting the following appearance: All the superficial veins of the right arm and hand are greatly dilated; those on the back of the fore-arm, above its middle, being much convoluted as well as swollen. The veins on the back of the hand are much contorted, and in various places varicose. On the little and ring fingers the veins present, in a well-marked manner, the appearance of aneurism by anastomosis, whereby these fingers are irregularly swollen to fully double their natural thickness. A little before the axillary artery becomes brachial, or just above the lower edge of the tendon of the latissimus dorsi, the vessel becomes abruptly dilated to fully four times its natural diameter. The dilatation is of the entire circumference, and extends about two inches along the brachial artery; its calibre is tolerably uniform or cylindri cal, except that on its anterior and internal surface it assumes a form somewhat irregular or nodulated. Above this dilatation, as far back as can be traced by the finger, the vessel, though not considerably dilated, feels larger than is natural, or than its corresponding portion on the opposite side. About two inches below the commencement of this dilatation, the artery as abruptly contracts. The contraction is |