REPORTS OF HOSPITAL PRACTICE IN MEDICINE AND SURGERY. THE CENTRAL LONDON SICK ASYLUM, HIGHGATE. NEPHR TIC ABSCESS-TAPPING-RECOVERY. (Under the care of Dr. DOWSE.) THIS case is exceptional, and worthy of record, although the diagnosis cannot be further verified. A similar case came under Dr. Dowse's care some years ago, in a girl of the same age, where the kidney was found to be a mere sac without any trace of its original structure. Harriet W., aged 18, was admitted with the following history-Five months previous to her confinement she experienced severe pain in the right lumbar region, which continued more or less until the time of her delivery, and almost immediately after the child was born pus was observed in the urine. When first seen after admission she was much exhausted, the pulse was weak, respiration hurried, the cheeks were suffused with a hectic flush, and the body bespattered with patches of erythema, in some parts nodose, in others purpuric. She was of a jaundiced hue, and there were other signs and symptoms indicative of blood-poisoning. The pain in the abdomen was severe, but confined more particularly to the right lumbar region. Upon examining the abdomen a swelling was found to occupy its right half, of regularly rounded and well-defined outline; it merged into the hypochondriac, umbilical, and inguinal regions, but filled up the whole of the lumbar. There was distinct fluctuation anteriorly as well as over the region of the kidney posteriorly. The urine was loaded with pus. With treatment the abdominal pain lessened, and the general health improved. The swelling continued to increase in size, and the urine to contain less pus until it was absolutely free. It was then decided to puncture, and an ordinary trocar was freely inserted, which liberated about twenty ounces of stinking, glutinous, purulent matter. After the trocar was withdrawn, the aperture was allowed to heal, and again pus made its appearance in the urine, and the swelling increased larger than ever. It was once more emptied, and kept so by means of a drainage-tube. For a week the discharge continued to make its escape freely, but produced little constitutional disturbance, the patient's temperature never exceeding 99o. From this time all pus-formation appeared gradually to cease; she made flesh, and left the building in excellent health. TRIPLICANE DISPENSARY, MADRAS. EXTRACT FROM THE ANNUAL REPORT OF OUT- Case 12.-Hepatitis existing for a long time without the knowledge of the patient-Termination in an Abscess-Complication with Diabetes Mellitus-Recovery by Resolution. ON October 27, 1871, at about six o'clock in the evening, Mr. David G., aged 39, sub-conductor in the Army Clothing Board, came to the Dispensary, complaining of" wind in the stomach,' and attributing the same to the use of a draught of arrack mixed with ginger and sugar. He complained also of nausea and of constipation of bowels for two days, and wished to have a draught to "expel the wind," and a pill to produce a motion. On examination, however, at the time of his application, I found him suffering from chronic hepatitis in its advanced stage, with an apprehension of its termination in an abscess, and the stomach was only slightly and secondarily affected from its vicinity to the left lobe of the liver, which was chiefly the seat of the disease. The symptoms were as follows:Fulness in the epigastrium on the right side of the mesial line, with severe pain on pressure; rigidity of the right abdominal muscles, particularly the rectus, which prevents the palpation of the liver near the margin of the ribs, where the organ is distinctly enlarged; sharp pain in the epigastrium as well as in the right hypochondrium on deep inspiration; en largement of the right lobe across the middle of the hypochondrium to the extent of an inch and a half; increased dul. ness about an inch beyond the upper boundary of the hepatic region; some uneasiness on lying on either side; pulse 100, small, not compressible; respirations 24; tongue brownishwhite in the centre; skin dry; bowels costive; urine said to be very scanty and high coloured; there was no cough or dyspnoea, nor pain in either of the shoulders. or in the back; the conjunctive were clear. Mr. G. is a thin and spare man, very intemperate in his habits, permanently subject to a tremor in the hands, and very nervous and weak. He was never seriously ill on any occasion during the last few years, but suffered occasionally from dyspepsia, gastralgia, congestion of the liver, etc. The liquor he is generally used to is the common country arrack, which he takes often mixed with ginger and sugar, as he did yesterday. The draught he took yesterday might have produced some irritation in the stomach and aggravated the hepatic inflammation; but the latter, I believe now, as I did yesterday, is of long duration, though he was not aware of it. The patient was astonished to hear that his liver was affected, and that there was fear of suppuration; and expressed doubts on this point, until he was convinced by the measurement of the side, and by the pain all over the hepatic region on deep inspiration. I admitted him at once as an out-patient, and insisted upon his not leaving his house upon any business. He was advised to have twelve or fifteen leeches applied to the most painful part, and to take the following pill at bedtime :-R. Ext. colocynth. co. gr. vj., pil. hydrarg. gr. iv., ext. hyoscyami gr. ij.—m. ; ft. pil. ij. This morning (28th) he looks much depressed and uneasy in mind, and has passed a restless night. He says that since his attention has been drawn to the disease, he feels the side heavy and uneasy, and there is more or less pain or tenderness in it. on every movement of the body. The pills have not acted as yet, and the leeches were not applied on account of some difficulty in procuring them in the night. But the painful parts. have been fomented freely two or three times, and with some relief on each occasion. He complains of nausea and loss of appetite. Pulse 104; respirations 24; skin dry; tongue foul, and brownish-white in the centre. Pulv. jalapæ co. 3j. immediately. Fomentation and sinapism over the hepatic region. Diet: Milk, bread, arrowroot-jelly, tea, etc. Evening: The medicine has opened his bowels freely three times; motions dark and offensive. He feels very easy, and there is no heaviness in the side, nor much pain in the epigastrium on pressure.. No nausea, but feels thirsty. Is inclining to be feverish at present. Pulse 108; skin warm; tongue cleaner, but slightly dry. R. Liq. ammoniæ acetatis 3 iij., spt. æther nitrici 388.,. mag. sulphat. 3 ss., ammon.-hydrochlor. gr. x., tinct. hyoscyami 3 ss., mist. camphoræ 3j.-m.; ft. haust.; every third hour. Continue sinapism and fomentations. October 29.-Appears worse this morning. The right abdominal muscles are more rigid than before, and there is constant pain in the right hypochondrium, with an occasional shooting towards the right shoulder. He has fever on him at present; feels very sick in the stomach; and has been vomiting in the morning two or three times, the matter rejected being chiefly bilious. Pulse 98 in the recumbent posture; skin hot on the trunk and almost cool on the extremities; tongue dry, and yellowish-brown in the centre. Dr. Duff saw the patient with me this morning, and prescribed the following:-No. 1: R. Ammon. sesquicarb. iv., acid. hydrocyanic. dil. mxl., tinct. cardamomi co. 3 vj., tinct.opii 3j., aquæ vj.m.; ft. mist. Sig.-A dessert-spoonful with the same quantity of No. 2, to be taken in a state of effervescence. No. 2: R. Acid. citric. 3 iij., aqua žvj.—m.; ft. mist. Sig. -A dessert-spoonful to be taken as above three or four times a day. Mustard poultice repeatedly. Diet: Beef-tea, chicken broth, milk. 30th.-Vomited only once since last report, and does not complain of nausea. There is more fulness in the epigastrium, but less pain all over the hepatic region, and also no shooting towards the right shoulder. The fever continues on him, and he felt chilly two or three times during the night. He is not able to rest on either side, back, or in any other position except in a semi-recumbent posture on an easy chair. Bowels have moved since last report; urine scanty, and not kept for examination; pulse 94, and softer; skin hot on the trunk and cook on the extremities; tongue brownish-white in the centre. Continue medicine and diet. To have a blister all over the hepatic region. November 1.-Mr. G. sent one of his friends (Mr. S.) to the Dispensary early this morning to inform me that he is suffering repeatedly from shiverings. I went over immediately, and found him just recovering from a fit of rigors. He was still shivering slightly, feeling cold and chilly, and covering himself with a blanket. There was no fever, and the extremities were cold, and he felt much relieved from pain. The fulness in the epigastrium is very prominent between the mesial line and the margin of the right ribs, and the blister is well risen over it. Omit effervescing draught. Dress the blister with sabine ointment. R. Acid. nitro-muriat. dil. 3 ij., quiniæ sulphat. gr. xij., tinct. gentian. co. 3 vj., syrup. aurantii 3 vj., aquæ 3vj.m.; ft. mist. A tablespoonful every third hour. Diet: Liebig's extract of meat, egg-flip, port wine. 2nd.-Passed a sleepless night; has had no rigor, chilliness, or fever since last report; complains of uneasiness and slight throbbing pain in the epigastrium; feels sick in the stomach, and is unable to lie on either side or back, and therefore sits up for the most part on an easy chair. Is not able to take much nourishment, for he says he feels more uneasy when the stomach is distended. The fulness in the epigastrium is more prominent than yesterday, and across this prominence the right side is about two inches and a quarter larger than the opposite one. Pulse 102 and small; respirations 30; skin warm on the trunk and cold and moist on the extremities; tongue cleaner and slightly yellowish-white in the centre; bowels moved once, motion yellowish-brown; urine very scanty and high coloured. Continue mixture; blister to be kept open; continue diet. R. chloral. hydrat. 9ij., aquæ cinnamon. 3ij.-m.; ft. haust. Half at bedtime and the other half to be repeated if necessary. 3rd. Did not sleep last night. He took only half of the draught, which he says made him feel "queer" in the head, and he therefore did not take the remaining half. He is in no respect worse than yesterday morning. Bowels moved freely once; urine is said to have been passed two or three times, and in larger quantity, during the night, but was not kept for examination. Blister is discharging well. Continue mixture; continue chloral at bedtime; continue diet. 4th. He says he has passed almost a restless night, partly from not inclining to sleep and partly from frequent micturition, and his urine is also more copious than ever in his life. He states also that he feels more easy and lighter in the side and in "the stomach" (meaning the epigastrium) than on any day since he had been placed on the sick report. The prominence in the epigastrium is surprisingly less, and there is little or no pain in the hepatic region on pressure or deep inspiration. The rigidity of abdominal muscles is also much less, and there is a decrease of about an inch in the measurement of the side. He can lie on either side or back, and move about his body without pain or uneasiness. In fact, he appears half well, but very weak, or, to use his own expression, "he feels as weak as a cat." He took one dose of the chloral at bedtime, but with the same bad effect as on the preceding night. Pulse about 92, soft and very compressible; skin cold on the extremities and dry on the trunk; tongue much cleaner in the centre and red at the edges and tip; bowels not open since last report; urine very copious yesterday and last night, particularly during the latter. I took the urine with me to the Dispensary, and examined it with the following result:-Quantity, 104 ounces; colour, whey, very frothy; reaction, slightly acid; specific gravity, 1026; sediment, very slight after a few hours' rest; sugar, sufficient to be easily detected by chemical tests; albumen, none; microscopical appearance, nothing abnormal. Continue mixture, and omit chloral at bedtime. As the diet which is in use now is chiefly animal, he is to continue the same. Is forbidden to take saccharine or farinaceous substances of any kind. 5th. I found him this morning sleeping on the left side comfortably on a cot. He thinks that he is well except for the weakness, and he passed a good night. There is no fulness whatever in the epigastrium, nor uneasiness except on the deepest inspiration. Urine ninety-six ounces during the day and night, specific gravity 1024, and saccharine distinctly; pulse 88 and soft; respirations 30; tongue clean; bowels moved once, motion scanty and hard. Has a good appetite. Complains of pain in the blister from the sabine ointment. Continue mixture and diet. 6th:-The right side is only one inch larger than the opposite one. There is neither fulness nor pain in the epigastrium, but he feels still some uneasiness or dull pain in the right hypochondrium on very deep inspiration. The muscles on the right side of the abdomen are nearly as soft as those on the other. The urine continues to be excessive in quantity, measuring about ninety ounces during the last twenty-four hours; specific gravity 1018, indistinctly saccharine on chemical tests. Continue mixture and diet. To have a blister over the right hypochondrium. 7th.-Urine only forty-eight ounces in twenty-four hours, and it is said to have been scalding, probably from the effects of the blister; its specific gravity is 1015, and it is not saccharine. No pain in the epigastrium on the deepest inspiration. Blister rose well and is discharging. Continue mixture and diet. 9th. He may now be considered as well. The right side is only half an inch larger than the left. Urine healthy in quantity and quality; pulse 80; respirations 20; skin acting; bowels regular, with healthy evacuations. He sleeps well and has a good appetite. Continue mixture. Heal up the blister. Diet: Bread, etc., as in health. Is directed to go out for a walk occasionally when there is no rain. 12th. Omit mixture. It was my intention to send Mr. G. on leave for a change of air and climate to Bangalore, with a view to recruit well his health before returning to duty, but he says he is not in a pecuniary condition to undertake the smallest journey. He is therefore directed to remain on sick report as convalescent until the end of this month, and to return to his business on the first of the next. December 4.-Mr. G. has improved a great deal since last report, and looks a fresh man. He says he feels more healthy and strong than he did for many months before his late illness. His right side is about half an inch permanently larger than the other, and, with this exception, the liver is healthy. The urine continues to be healthy also. His bowels were rather loose from indigestion on the 1st instant, and he therefore did not return to duty as intended; he returns to-day. Discharged. Remarks. In this country inflammation of the liver is often so insidious that it does not excite any suspicion of its existence in the mind of the patient until it is brought to light from some accidental occurrence. The above is exactly a case of this kind. When Mr. G. presented himself at the Dispensary on October 27 he had not the least idea of the state in which his liver was, and he thought he was quite well except a "wind in the stomach," owing to the use of arrack with ginger, etc., as mentioned in the case. He was much surprised to hear that his liver was affected, and did not believe it until it was proved by pain all over the hepatic region on deep inspiration, and by the enlargement of the right side to the extent of an inch and a half. In addition to these there were two other very important diagnostic symptoms-viz., the fulness or prominence in the epigastrium on the right side of the mesial line, and the rigidity of the right rectus muscle. From these symptoms there was no doubt in my mind that the patient was labouring under chronic hepatitis, which was nearly terminating in an abscess, and which must have been lingering upon him for weeks or months-yet he was not aware of its existence. I imparted my view of his case to Mr. G., and insisted upon his reporting sick and confining himself to the house. About three days after admission he suffered repeatedly from severe rigors, with a sudden abatement in all the prominent symptoms, and with an increase of about three-quarters of an inch in the enlargement of the side, which indicated the formation of an abscess, as already anticipated. The abscess was in the left lobe of the liver, for, in addition to several other symptoms showing that part to be more affected than any other, the prominence in the epigastrium was simultaneous with the occurrence of rigors. As a blister was already applied over the hepatic region before the abscess was formed, I kept it open afterwards, and began with the use of nitro-muriatic acid with small doses of quinine, and gave the patient more nourishing diet than before. Though this is the best treatment, according to my own experience in hepatic abscesses under ordinary circumstances and before they are quite fit for evacuation, yet I could not attribute to it alone the great rapidity with which the patient recovered in this case. It is chiefly and directly attributable to the temporary diabetes mellitus which occurred two days after the formation of the abscess, and continued for four or five days, at the end of which period the patient was almost well. Though a disease itself, the copious secretion of urine seems to have acted as a drain on the system, and thus promoted the absorption of the matter in the liver. I am not aware of any other recorded case of hepatic abscess or hepatitis which has been complicated by diabetes mellitus, and this is, therefore, the most interesting feature in the case under consideration. It requires a few words by way of explanation. On the morning of November 4, the change for the better being very great and sudden, I made inquiry as to the cause of it, and found nothing to account for it satisfactorily, except the secretion of urine, which was surprisingly great during the previous twenty-four hours. Its quantity was 104 ounces, while a day before that period it scarcely amounted to eight or ten in the same space of time. Besides the copiousness the urine was of a whey colour, with a great deal of froth, and a specific gravity of 1026, and it contained a sufficient quantity of sugar to be easily and readily detected by Moore's and Trommer's tests. It continued to be saccharine only four or five days, and then it lost this character as suddenly as it assumed it. Its quantity, too, was reduced to its average in health as soon as the sugar disappeared. Now, what is the cause of the sudden diabetic condition of urine in this case? As far as I can see and think of, there was nothing which could reasonably be assigned as a cause of this condition, except the use of chloral hydrate. A draught containing forty grains of this medicine was prescribed for the first time on the night of November 2, half of which was to be taken at bedtime to procure sleep, and the other half to be repeated if necessary. Only one dose was used by the patient, which did not produce the desired effect, but increased the secretion of urine during the night. On the following morning the urine was said to have been voided more frequently and in larger quantity, but was not kept for inspection. On the night of the 3rd he took the remaining dose of the medicine, and with the same failure with regard to sleep as in the preceding night, but the urine was found excessive in quantity, saccharine, etc., as explained in the case. The above circumstances show a direct connexion between the use of chloral hydrate and the diabetes mellitus in this case, and I am therefore inclined to look upon them in the light of cause and effect respectively. Chloral is a very active medicine lately brought into use, and its action upon the system under many circumstances is not yet known. It is possible that it sometimes excites the liver to secrete more sugar or glycogen than natural, but in what way and under what circumstances I cannot say. A single case like the one under discussion is not enough from which to form an opinion on this point. Chloral is a very good hypnotic medicine, but its failure in this case was owing to the smallness of the dose (one scruple). Had the dose been repeated as directed, I have no doubt that it would have produced the desired effect. The secretion of sugar in so large a quantity as to render the urine diabetic while the liver was already diseased is another unusual thing in this case requiring explanation. As far as my experience goes, in ordinary cases of hepatic abscess and hepatitis, the liver often continues to secrete bile, and occasionally to such an extent that it is brought up in large quantities by frequent vomiting. When it is so, it is not unreasonable to think that the organ, under the same circumstances, is also capable of keeping up the secretion of glycogen or sugar, and of secreting the same sometimes in a larger quantity so as to produce a temporary diabetes. The lungs were quite healthy during the late illness of the patient, as well as previous and subsequent to that period, and the diabetes in this case, therefore, was not owing to any deficient pulmonary action, but solely to excess of hepatic function. (To be continued.) EXAMINATION OF THE URINE FOR LIFE ASSURANCE. -Prof. Austin Flint, jun., has recently published an excellent little pamphlet, entitled "Directions for the Examination of Urine of Applicants for Life Insurance." While we can hardly agree with those who advocate the practice of examining the urine of every applicant for life assurance, we certainly think that the companies would avoid not a few bad risks were they to insist upon such examination in the case of all applicants who have reached their fiftieth, or perhaps even their forty-fifth year. If we are correctly informed, it has been for some time the custom with one of the New England companies to require this examination in quite a large proportion of the applicants for policies. It would be very interesting to know how successful they have been in carrying out the plan, and what have been the real difficulties in the way of its accomplishment.-Med. Record, September 15. DOCTORS AND DRUGGISTS. IN passing through many of the humbler streets of London and other large towns, a professional observer cannot fail to be struck with the very faint and often entirely imperceptible line which separates medical practitioners from druggists. The glaring lamp fixed in the most commanding situation; the most elaborate description in sign-board print of its professional owner; the ostentatious display of diplomas, and the mysterious exhibition of bottled pathological specimens,—all show that in many instances the medical man has been impelled by force of circumstances to lay aside the dignity of his profession and assume the position of a tradesman. For the existence of such a state of matters, unfortunate though it may be, many valid excuses can be adduced by those who practise in open surgeries. The poverty of the mass of the people amongst whom they practise, their incapability of appreciating unostentatious merit, and the statement that but for open surgeries chemists and druggists would, incapable as they are, be called upon to do the whole practice of such neighbourhoods, are all excuses for the renouncement of professional dignity. Undoubtedly each of these arguments is to some extent applicable to the case, but at the same time there are frequently other reasons which influence medical men in laying themselves out more as dealers in drugs than as dispensers of medical advice and assistance. In the first place, both on account of their lower marketable value and of the greater rapidity with which they form around a man, these practices are assumed with less difficulty than are the higher social positions in the medical profession. They generally carry along with them the recommendation of ready money; and though severally the sums secured are small, the aggregate reaches in many instances to no inconsiderable amount. There can be no doubt that considerations like these often influence men in determining their temporary or permanent devotion to a line of practice which at first must seem to all medical men undignified and, in many respects, prejudicial to the high character of the profession. But nothing is more antagonistic to dignity than the res angusta; and young men of great merit, disinclined to country practice, and unable to command sufficient capital to commence work in a higher sphere, are often driven to the assumption of a class of practice which they inwardly dislike, and the greatest drawback of which is, that it combines the profession of a doctor with the trade of a chemist. To such an one it may be held out as an extra inducement, perhaps, that he can even outvie the chemist by establishing a provident dispensary, where he can dispose of medicines at sixpence a bottle, and superintend the process of parturition at the rate of ten shillings a presentation, paid beforehand by subscriptions. In the medical profession such practices are constantly disposed of as a stepping-stone to higher things, and no doubt many men make large sums of money by the administration of such institutions, while others tide over their early difficulties by the incessant plodding and undignified counter practice of an East-end open surgery. Nor is the system without its analogies in higher practice. The great mass of town practitioners dispensing from private surgeries receive little, if any, more remuneration for advice and medicine than would be paid for the medicine alone to a respectable chemist. There can be no doubt that the existence of such a state of matters in the medical profession shows a "levelling-down" towards the position of the simple chemist which requires to be guarded against. The caution required should be all the greater when it is remembered that for many years chemists have been "levelling up" towards the profession of medicine. The apothecary characteristic of Shakespeare's time, who stood "In tattered weeds; with overwhelming brows, had, in the time of Pope, come to be represented by who, By doctors' rules to play the doctor's part," "Bold in the practice of mistaken rules, Prescribe, dispense, and call their masters fools." And from that time to this the great mass of apothecaries, (a) and chemists who now represent them, have either pursued the plan satirised by Pope, or have habitually supplemented a mock examination into signs and symptoms by the exhibition of a weather-beaten formula of the kind designated refrigerant in exchange for the silver coin of the credulous patient. And if in the poet Butler's time they were content to "Cure warts and corns with application they now crowd windows and counters with patent medicines in an endless variety, which fills one with astonishment that people should so freely pay for substances so inert or that so few fatal accidents are traceable to patent drugs. Or, perhaps, the enterprising young chemist, gifted with a higher education than his predecessors, gets possession of a Greek compound, a Greek and Latin conglomeration, or still better a term in organic chemistry, and, enveloped in a pictorial or printed wrapper, his new combination passes muster with the drugdrinking public as equivalent to a shilling and a fraction of unimpeachable coin. Even into the domain of surgery the modern druggist is not backward to enter, and in the region of obstetrics he often takes a lucrative though rather surreptitious place between the midwife and the accoucheur. These encroachments are no doubt matters of importance to the lower orders, socially speaking, of the medical profession, especially as they are daily progressing almost entirely unchecked. And when chemists and druggists are remonstrated with on account of the grievance, the excuse which they adduce has a certain amount of reason on its side. They naturally say to doctors who keep open surgeries, "You do our (a) The apothecary of the present century must not be confounded with the apothecary of olden times. Since the passing of the Apothecaries Act, 1815, the full apothecary has been a qualified medical practitioner. work, you take the bread from our mouths, and consequently we must encroach upon you." And if the competition is to be carried to its utmost extent between the two parties; if it is to be a case of "pull doctor, pull druggist," one of two things must inevitably happen. The method in which trade is carried on in low thoroughfares shows that he who can manifest most display and bring himself forward with the greatest ostentation will command the largest patronage. Consequently, the druggist, being free from all trammels of professional restraint, will win the day. If not, the second and more unfortunate alternative must ensue. The commercial doctor, carried along by the excitement of competition and the desire for gain, must throw aside the reserve and dignity which have hitherto been regarded as the attributes of all classes of medical practitioners except the itinerant destroyer of non-existent tapeworms and the ectrotic suppressor of contagious diseases. The taint will advance into higher circles. Men dispensing from private surgeries will extend their not uncommon practice of retailing drugs, and the good name of the medical profession in large towns will run the risk of being defamed by that familiarity which proverbially breeds contempt. Undoubtedly men of all grades in the profession of medicine must strive to secure a competency from the practice of that profession, and their method of doing so must in all cases be modified by their "environments." But, at the same time, medical men must endeavour to remember that by social position, by education, and by admission into a learned profession they are superior to dealers in drugs, and must guard against the infliction of that injury to the whole body to which they belong which might readily accrue from introducing a purely and ostentatiously commercial element into the exercise of a dignified and honourable profession. THE ETIOLOGY OF DIABETES MELLITUS. IN the Berliner Klinische Wochenschrift of November 2, Dr. Schmitz, of Neuenahr, points out that hereditary predisposition has probably more to do with the development of diabetes than almost anything else. Mental anxiety, severe pain, and injuries of various kinds, whether they affect the nervous system or not, seem to be powerless to set up the disease without this inherited tendency. Of 104 patients observed and treated by the author since 1868, and in whom the family history was most carefully inquired into, twenty-two were found to have had diabetic parents or relations; and if those cases had been included in the list in which the patients "believed" that other members of their family had been similarly affected, but were not absolutely certain of the fact, the numbers would have been much higher. Dr. Schmitz remarks with truth how little many persons know of their relatives' illnesses, and quotes Seegen's observation that many cases of diabetes are probably never recognised. Of the twenty-two patients in whom the disease was hereditary, the grandfather of one was diabetic, and the father and grandfather of another. In six cases the father, and in six others the mother and sisters were diabetic, and in eight the sisters only. Dr. Schmitz, however, only looks on hereditariness as a predisposing cause, and he brings forward several interesting cases to show how the tendency may remain latent for years until some sudden mental trouble or bodily injury calls it, as it were, into life. One patient, Herr F., fifty-seven years of age, had lost his father from diabetes, but all the other members of his family were healthy. His own health had previously been excellent, when one day a favourite daughter committed suicide in a fit of melancholia. He was almost immediately seized with dyspepsia and intestinal catarrh, and had an attack of jaundice, from which he partially recovered, but soon began to lose flesh and strength, and thirst and polyuria set in. A month later his urine contained 5 per cent. of sugar, and he soon exhibited all the symptoms of confirmed diabetes. His son Franz, twenty-six years old, enjoyed excellent health until, in September, 1871, he fell from his horse, and severely fractured his left leg. The accident was followed by agonising pains in the limb during the first few days which succeeded it, and a fortnight afterwards the subjective phenomena of diabetes set in, and on examination his urine was found to contain 6 per cent. of sugar. Absolute diet, alkalies, and opium speedily improved his condition, but in June, 1872, there was still about 1 per cent. of sugar present. The remarkable feature of these two cases is, that although the father of one patient, and the grandfather and the father of the other, had both been diabetic, they both remained in good health until a severe nervous shock brought out the latent disease. The suicide of the daughter in a fit of insanity is also worthy of note, because it seems to favour the relation between mental affections and diabetes. Another interesting example of diabetes following mental anxiety in a patient hereditarily predisposed is given by Dr. Schmitz. A man, aged twenty-eight, always healthy until his present illness, had lost an aunt (mother's sister), a sister, and a niece of diabetes, and his brother was a sufferer from the same disease when he himself came under observation. His father died of typhus; his mother is still alive, and suffers from rheumatic gout. For the last seven years he has worked excessively hard in his father's business without taking proper rest or holiday, and has lately been much worried by unsuccessful commercial transactions. Lately he has developed all the symptoms of diabetes, and his urine contains 1.5 per cent. of sugar. A fourth case which the author brings forward in favour of his theory of some severe mental or bodily injury being necessary for the development of an hereditary diabetic taint, seems to us less satisfactory on that point than the others. A woman, who had enjoyed good general health with the exception of occasional attacks of diarrhoea up to her fiftieth year, was attacked with violent prurigo pudendorum in the autumn of 1871, and the irritation became so frightfully severe that for eight months she scarcely slept at all, and was, according to her own account, almost driven out of her mind by it. In the spring of 1872 she had all the symptoms of diabetes, and sugar was found in her urine; but as the summer came on the prurigo diminished, and the diabetic symptoms became coincidently less pronounced. Under treatment with opium and valerian the patient improved, and both prurigo and diabetes became remarkably reduced. There was always, however, an increase of sugar in the urine with increase of the prurigo. It should be mentioned that the patient's mother and four sisters were all diabetic. Dr. Schmitz explains the case as follows:-The first onset of the disease was due to the mental prostration and shock caused by the prurigo pudendorum, and each subsequent exacerbation of the diabetic symptoms was likewise due to the nervous condition (Nervosität) set up by a fresh outbreak of prurigo. Dr. Schmitz therefore makes the diabetes secondary to the prurigo, while we should rather look on the prurigo as secondary to the diabetes. Prurigo pudendorum is a common accompaniment of that disease in women, and to our own knowledge it is the symptom which often leads to the first examination of the urine and the discovery of sugar in it; and it is to the presence of this sugar, and the irritation which it excites by its contact with the genitals during and after the patient's frequent acts of micturition, that the prurigo is due. The simultaneous increase and diminution of this distressing symptom and of the percentage of sugar in the urine is explained equally well on this theory as on that of Dr. Schmitz. The hereditary predisposition is clear enough in this case, but not the determining cause. ST. ANDREWS UNIVERSITY. THE General Council of this University met on November 27 in the Hall of the United Colleges. The principal business before the meeting related to the proposed amendment of the Scottish Universities Act. The speakers expressed the conviction that the unanimous intention of the representatives of the four Universities was to strengthen the hands of the councils and improve the condition of the different Universities. The proposal to have additional assessors for the Universities of Glasgow and Aberdeen was shown to have been approved of by their respective Councils, and agreed to. It has been agreed also that a new section should be added to the draft Bill, providing that all measures involving internal improvements should be submitted to the Councils by the University Courts. Special reference was at the meeting of Council made to the clause in the draft Bill which directly relates to St. Andrews University. It proposes that three additional members should sit in the University Court-namely, the Principal of the United Colleges, and two others chosen by the Council. Professor Flint, in referring to the Committee's report to the Council, approved of the proposal to increase the numbers of the University Court, but expressed a certain amount of dubiety regarding the construction of a draft Bill for the amendment of the Universities Act. Such a course would lead Government to understand that the constitution of the Scottish Universities would work satisfactorily if its defects were patched up by amendments. He advocated the removal of the patronage of professorships from the University Courts and the construction of a single elective body for all the four Universities, composed of representatives from the House of Lords, the House of Commons, and the learned professions. A motion was carried, reappointing the Committee of Inspection, and requesting them to endeavour to secure the appointment of a Royal Commission to investigate and report upon the constitution of the Scottish Universities previous to any legislation on the subject. Aberdeen University favours the same course. The Council subsequently considered the project of extending the advantages of the teaching of the University to Dundee. There appeared to be considerable diversity of opinion upon the subject, and a want of maturity in the opinions and ideas held by the supporters of the scheme and others. There can be little doubt that if St. Andrews does not endeavour to do its duty by Dundee, in the way of supplying such general and technical teaching as that large and increasing centre of industry may require, the University may miss an opportunity of advancing its own welfare which may never recur. The other Universities in Scotland are already and of necessity identified with large towns, and participate more or less in the progress which all large centres of the population manifest in social and political evolution. But St. Andrews is exceptionally retired, and to all appearance ought to take advantage of its close proximity to Dundee to secure for itself an advantage which it alone does not possess. The subject has been much agitated in Dundee, and proposals have emanated from leading men to the University of St. Andrews. They ask for systematic courses of lectures, and now intimate that the whole matter is to be taken up by the Town Council of Dundee, with the certain prospect that the people will take decided action in the matter. Professor Campbell advocated the establishment of a school of science in Dundee in connexion with St. Andrews Univer sity, and supported the establishment of classes to be superintended by lecturers recognised by the University. Mr. Patrick Anderson was in favour of a Dundee College to be affiliated with St. Andrews University. On both sides "serious consideration" has been determined on, and there |