opinion that diabetic sugar is strictly identical with that obtained from fecula.

"M. Rayer's patient was seized with a pneumonia, while under treatment for the diabetes. The animal diet was, therefore, obliged to be suspended. The urine, under the influence of the inflammatory action, became of a deeper colour, and was found to contain much less sugar. Five days after the invasion of the inflammatory symptoms, and seven days after the suspension of animal food, the urine was found to exhibit no traces whatever of rotatory power: consequently all secretion of sugar had ceased. "How much more easy it would have been to have treated this case, had the poor fellow come to the hospital at the commencement of his disease, when the simple inspection of his urine might have proclaimed at once the danger of his situation!

"In another case from the practice of M. Rayer, that of a child in whom there was a copious diuresis, accompanied with extreme thirst, &c. I examined the urine optically, but could not discover any sign of rotatory power. Now on evaporating it, we found that there was exceedingly little residue left, and that this was not fermentable. The optical and the chemical examination corresponded, therefore, in their results. It is, without doubt, easy in such a case to ascertain the nature of the urine by evaporating it, and testing the residue; but it is still more easy to introduce some of the urine into a tube, and arrive at the same conclusion by simple inspection."

M. Biot suggests to physicians, that by following this plan, the optical examination of the auimal fluids, they might ascertain whether the serum of the blood, &c. in diabetes contains any free saccharine matter. He has already found that the serum of healthy fluid has a rotatory power directed to the left hand-in consequence of its containing albumen, which acts in this direction. If the serum contained any sugar, we may expect that its rotatory power should be considerably weakened, or perhaps altogether changed. A similar occurrence may be expected in the urine itself, when it has become albuminous. These are questions well deserving the immediate attention of the scientific physician.

M. Biot concludes his remarks with these words:

"The optical characters of the urinary secretion will furnish an easy, sure, and exact means of diagnosis, to enable us to ascertain in a moment its diabetic condition. In this way, we may recognise the commencement of the disease from its earliest stage, detect at once its different peculiarities, and follow it through all its phases. It will then be easy to discover the immediate effects of regimen and diet, as well as of any medicinal agents that may be administered."-Gazette Medicale.

ART. I.-NOTE ON A CASE OF EXPOSURE OF THE VENTRICLES OF THE LARYNX.

BY THE EDITOR.

Through the kindness of Dr. Ashmead, our colleague in the Philadelphia Hospital, we had an opportunity of examining a case in which the larynx had been freely opened, some time ago, with the object of committing suicide. Adhesion had taken place between the edges of the posterior part of the wound, but the aperture anteriorly was sufficient to allow the inferior ligaments to be distinctly seen. The original wound appeared to have passed immediately through the ventricles of the larynx; and in the process of cicatrisation, considerable deposition had taken place anteriorly, so that the ligaments of the glottis are not left free to vibrate.

The following observations were made at our visit, and were noted by Dr. Selden, one of the resident physicians of the institution. They were confirmed at a subsequent visit with Dr. Pennock and Dr. Lakey, of Cincinnati.

First, The arytenoid cartilages approach during expiration and separate on inspiration, when the breathing is quiet. When it is agitated, they approach and recede irregularly.

Secondly, During deglutition, whilst the larynx rises under the base of the tongue, the opening of the glottis-rima glottidis-is completely closed by the contraction of the intrinsic muscles of the larynx.

[It was manifest, that this action must totally prevent the entrance of substances into the trachea during deglutition.]

Thirdly, When odorous substances were held to the nose-the aperture of the throat being open-their smell was correctly appreciated; but by no means as distinctly as when the aperture was closed.

[Perrault, Lower, and Chaussier found, that by making an opening into the trachea of an animal, smell was not effected, and that dogs, which were the subject of the experiment, readily ate food they had previously refused.] Fourthly, During the production of voice, whilst the aperture was left free, the voice was exceedingly raucous and indistinct. When the aperture was closed, it was still very raucous, but the words could be distinguished.

In the production of all vocal sounds, the glottis appeared to be almost entirely closed. When the aperture was free, the simple vowel sounds could not be distinguished from each other; but the letter I, which is a diphthong, could be discriminated from the rest.

[The great indistinctness of the sounds, when the aperture was open, appeared to be mainly owing to the tumefaction described above as existing anteriorly, and which acted, to a certain degree, as a damper to the vibrating cords. When the aperture was closed, and the air passed immediately upwards, greater freedom of vibration was permitted, and the different sounds were more appreciable.]

Owing to the tumefaction of the parts, no satisfactory observations could be made on the condition of the vocal cords in the production of grave and acute sounds.

ART. II.-REPORT ON BILLS OF MORTALITY.1

The proper mode of framing public registers of deaths was pretty fully considered by a committee of the British Association, which was appointed at the meeting held in this city, in 1834, and reported to the subsequent meeting of the Association in Dublin, in 1835. At that time, "the Act for Registering Births, Deaths, and Marriages in England," was only in contemplation, and it was expected that a similar Act for Scotland would be introduced into parliament. The English Bill became law in 1837, but the Scottish Bill, in consequence, as is said, of the opposition made to it by the parish-clerks throughout the country, has been hitherto postponed. It seems hardly possible, however, that the numerous benefits which our sister-country derives from an effective system of registration, should not, within a reasonable time, be extended to Scotland; and it may be hoped that the recent decided expression of opinion by the Statistical Section of the British Association, respecting the importance of the measure, will contribute to this end.

It is obviously of importance, therefore, that the attention of the profession in Scotland should be again directed to the subject of the registration of deaths, and to the advantages, as regards not only the interests of the public, but the progress of medical science, which may be expected to result from a well-regulated system of registration; and this more particularly, as the plan of keeping such resisters, introduced by the English Bill, (which is considerably different from that previously recommended by the Edinburgh committee,) and the statistical nosology recommended by the registrargeneral, for the use of practitioners in filling up the returns of the causes of death, appear to your committee liable to serious objections.

With two observations, contained in the letter on Statistical Nosology, prefixed to the table of diseases drawn up by Mr. Farr, and both of which are contained in the Remarks on the Registration of Deaths, that were laid before the British Association by the sub-committee formed at Edinburgh in 1834, all must concur.

The first of these relates to the importance of retaining the old division of diseases into plagues and sporadic diseases, or in other words, into, 1st, those diseases which are confined to limited districts and limited periods

'Report of a Committee of the Royal College of Physicians of Edinburgh, appointed to consider the best mode of framing Public Registers of Deaths. (Approved by the Royal College, February 17, 1841.)-Edinburgh Medical and Surgical Journal, July, 1841, p. 140.

which are either endemic or epidemic; and 2d, those which proceed from causes acting pretty uniformly on every large mass of mankind, and which are found accordingly, although influenced by climate and season, to prevail more or less, and to produce a larger or smaller annual mortality, in all countries.

This distinction at once recommends itself to the common sense of mankind, and perhaps the most correct scientific account we can give of it is by saying, that one class of diseases is the result of specific poisons, of various sorts, introduced into the animal economy, and the other of morbid actions, excited by causes which are very generally applied, and are not necessarily deleterious in their effects. But the allocation of individual diseases, in one or other of these great divisions, is attended with difficulty, and the plan adopted in the English table is in several respects unsatisfactory.

The second of the two observations referred to, is that, in sporadic diseases, it is generally easier to distinguish the region, or even the organ, primarily and chiefly affected, than to ascertain the precise nature of the disease. The importance of this observation appears to your committee not to have been sufficiently appreciated in forming the registration lists of diseases for England; and to suggest the only distinction that ought to be observed between a statistical nosology, and a nosology for the use of schools of medicine.

To these we would add only one other preliminary observation, which is the foundation of the criticism to be offered on the tables of the causes of death, drawn up by Mr. Farr, and used in the returns under the English Registration Bill, viz.—That in constructing such returns, it is better to acknowledge ignorance, than to run the risk of proclaiming error-better to rest satisfied with a smaller amount of information, of which we can be absolutely certain, than to attempt to procure a larger amount, at the risk of the facts being so much blended with opinions, as to make numerical statements a possible source of misapprehension and erroneous doctrine.

It is to be observed, that certain articles of information in regard to all the deaths that occur in a district, may be accurately and uniformly given in the registers, and be of much importance in various medical inquiries (because enabling us to construct tables illustrating with certainty the influence of various causes on health,) altogether independently of any medical opinions as to the causes of death; viz. the age, the sex, the precise date of death, the occupation of the deceased person, or that of the head of the family to which he belonged, the precise locality of his residence, the part of the body chiefly affected by the fatal disease, and, in a general way, the duration of his disease. The report of the Edinburgh sub-committee laid some stress on the importance of all registers containing details on the two last of these heads; and suggested, that all the deaths should be ranked as depending on acute or chronic diseases, according as the patient should have been known to be ill, and disabled for his ordinary occupations for less or more than six weeks before death. We regret to perceive no evidence that effectual provision is made in the registers kept under the act now in force in England for any of the last mentioned points being uniformly and regularly ascertained.

In proceeding farther, it must always be kept in mind, first, That to a very large proportion of the deaths registered, no report of the cause of death, by a medical man, will be annexed; and, secondly, That such a report, when given, unless much care be taken, may very often be founded in a great measure on opinion, not on ascertained facts. But, conformably with the principles above laid down, it is desirable that all the cases of sporadic diseases should be entered according to the seat of what was regarded as the chief affection-as acute or chronic disease of the head, of the chest, of the stomach or bowels, (including affections of the liver and other chylopoietic viscera,) of the urinary organs, of the genital organs, of the bones or joints, or of external parts. This may be done, as was observed by the

committee of the Association, without any report by a medical man; but it will of course be done with more accuracy by medical practitioners. Farther, it would be desirable that the accurate specification of the organ, or the more precise name of the disease, should be given only when furnished by a medical practitioner, and should be stated in a separate column; and that practitioners should be requested to specify the name only in those cases in which they can announce it with confidence and precision. Thus we might have, e. g. one hundred cases of death reported as resulting from diseases of the chest, forty of these marked as acute cases, and of these forty, perhaps only ten would be named; but the names given, being in conformity to instructions, as simple as possible, issued to all medical men, and to none others, would be understood alike by all, and therefore be deserving of confidence.

Thus we should have in every register of deaths, two distinct columns— the one to be filled up in all cases, the other only in some cases, from which, of course, two lists may be at any time made up, the first illustrating many important points relative to disease, although containing no nosological name; the second affording as good security as the state of medical science and medical instruction permits, that the names of diseases given in it are given uniformly, and applied similarly in all parts of the country. Each of these columns would be subdivided in the way to be afterwards mentioned. The construction of the list of diseases, to be recommended by authority to all practitioners, is the subject of greatest difficulty connected with the registration of deaths, and that in which the plan adopted in England seems liable to the greatest objection. But we regard it as a fundamental principle, that practitioners should be strongly advised rather to content themselves with stating the seat of the disease causing death, and its course as acute or chronic, than to affix a name to it, without possessing certain evidence, from examination of the body or other unequivocal indications, of the name they affix being the right one.

The importance of this caution appears from the tables published in England. We do not refer to the whole list of diseases, about 180 in number, given under the name of Statistical Nosology, which seems very deficient in simplicity, (comprising, for example, six distinct names for varieties of the continued fever of this country,) but would refer particularly to the abstract of the causes of death in the registers contained in page 120 of the first report. The names there given are certainly a great improvement on the ancient bills of mortality; but we think it easy to show that the objections justly urged by Mr. Farr against the old nomenclature, that "each disease has been denoted by different terms, and each term applied to different diseases-that vague, inconvenient names have been employed, and complications been registered instead of primary diseases"-have been by no means uniformly avoided.

The first objection which occurs to us to this "abstract of the causes of death," is, that cholera, (distinguished from the Asiatic or malignant cholera,) croup, diarrhoea, thrush, dysentery, and erysipelas, are all set down among the plagues, i. e. the epidemic, endemic, and contagious diseases. We submit that the three first of these should be excluded from this head of diseases altogether; and this more especially as, besides 1655 cases of croup, ranked among the epidemics, we have, under the head of sporadic diseases, in the same table, 24 from laryngitis and 289 from quinsy. We apprehend that it would be much simpler, and more scientific, to have all these ranked together, in the first instance, as acute diseases of the windpipe, and very much doubt if any advantage is to be derived from more minute distinctions among them.

Again, we have, among the epidemic diseases, 460 deaths from cholera, 2755 from diarrhea, and 675 from dysentery; and then we have, among the sporadic diseases, 170 from ulceration of the bowels, 3396 from gastro enteritis, and 853 from disease of the bowels, besides 437 from tabes mesenterica,