fair and candid ftatement of fymptoms, and the refult of the practice in removing them. It would be improper, at this time, to enter upon a particular difcuffion of Dr Rollo's opinions. We shall therefore content ourfelves with briefly noticing the leading points of his theory, because it correfponds with that now under confideration. Dr Rollo alleges, that diabetes confifts in an increased morbid action of the ftomach, with too great a fecretion, and an alteration in the quality of the gastric fluid, producing faccharine matter, by a decompofition of the vegetable fubftances taken in with the food, which remains unchanged. p. 387. (Cafes of Diabetes Mellitus, 2nd Edition.) The arguments adduced in fupport of this opinion, are not very convincing. Indeed, unless the queftion be affumed, it is difficult to discover that the increafed appetite and frequent cravings are more in proof of this opinion, than of the very oppofite. As far as the ftomach is concerned, the procefs of digeftion feems regularly and rapidly performed; hence, that organ cannot be confidered as primarily difeafed. The symptoms firtt noticed by the patients, are not fuch as to lead us to fufpect any morbid ftate of the ftomach, and, in many instances, those mentioned by Dr Rollo, are wholy wanting. All writers feem to coincide in saying, that there is fome morbid state of the ftomach, fome imperfect affimilation of the food taken in. But this is no explanation-it is only the expreffion of a fact-it is only faying that fome imperfection takes place in a process confeffedly unknown: it does not lead us to the ultimate object of our inquiry, nor remove the difficulty in accounting for the phenomena. There is, according to Dr Rollo, a fugar-making procefs going on in the ftomach; and, according to Mers Nicolas Gueudeville, the fluids of the ftomach, liver and pancreas, are changed by the prefence of ill-formed chyle. These fuppofitions are perfectly gratuitous. If fugar is formed in the ftomach, it must be from the alimentary matter undergoing the fermentative procefs; but the experiments of Spallanzani fufficiently prove, that no fermentation takes place in healthy digef tion, and we have no marks of this procefs in diabetes. Suppof ing faccharine matter to be formed in the procefs of digeftion, it must be contained in the blood; and numerous experiments have been made to detect it, but without fuccefs. Dr Dobson is the only one who found the ferum rather sweetifh.' This must be confidered as accidental, especially as numerous recent trials have found the taste of the ferum faline, and the other parts perfectly natural. It may be said, that faccharine matter exifts in the blood, fo combined as to escape any tests employed to detect it. Ee3 Such Such an objection cannot be obviated by reafoning: it must be left to future difcoveries. Thofe who attribute the primary caufe of diabetes to a morbid ftate of the affimilating organs, look upon the kidneys merely as filters, defigned to feparate and carry off the excrementitious part of the blood. But this is contradicted by a due attention to the glandular ftructure of these organs, their complex formation, and, above all, by fubftances being found in the urine, which have never been detected in the blood or any other part. Modern chemistry has fhewn that the elements of fugar are contained in the chyle; but it is not fo fatisfactorily afcertained, that faccharine matter, already formed, exifts in this fluid. The different fecretions are fo mutually dependent on each other, and fo various and intricate are the fe veral proceffes through which they all pafs, that it feems unfair to attribute to one procefs, what may be the refult of feveral. Carbon, oxygen, and hydrogen, exift in fufficient abundance in the animal body; by their combination, they may be fuppofed readily to furnish that peculiar fweetness to the urine. Dr Lubbock has conjectured that the fuppreffion of the perfpiration which is very remarkable in this disease, may conduce to the combina tion of the elementary principles of fugar. This fuppofition is recommended by its ingenuity, but it requires to be determined by more accurate experiments. The fame want of experiments, makes us fceptical with regard to the fuppofed altered ftate of the other fecretions of the body. The next affertion to be examined, is, that the quantity of urine evacuated is in excess, in confequence of the fuppreffion of the other excretions. Hitherto, there has been no cause pointed out, why the quantity of urine difcharged, fhould exceed the liquid ingefta; and the reafon now alleged is a very poor one. On this fubject, we cannot help again referring to the very acute and ingenious obfervations of Dr Lubbock, who firft detec ted and pointed out a very popular error in the history of this disease *. In all thofe cafes, where the quantity of liquid ingefta has been accurately measured and faithfully recorded, it has almoft invariably been found to correfpond with the quanti ty of urine difcharged. Any little excefs may, in general, be readily accounted for, by confidering the proportion of folid ingefta converted into a fluid ftate. In fome inftances, we know that the urine has appeared to exceed the quantity both of liquid and folid ingefta; but, in thefe cafes, it has at length been dif covered, that the patients were often guilty of irregularity in their diet, and that the account of their actions could not be de ✦ Țide Medical and Phyfical Journal, Vol. V. pended pended upon. That the quantity of urine is in exact ratio to the fluids taken into the ftomach, is a fact of confiderable importance; and, if well established, of which there feems now little doubt, it will at once fet afide any frivolous and trifling difcufhon concerning the origin of the fuppofed fuperabundant water. The marvellous relations which are met with in old authors, may be placed on the fame fhelf with the hiftories of fur prifing cures by the royal touch, and fuch forgotten things.' In making further inquiries on this fubject, there is one fource of fallacy to be guarded against, which deferves to be pointed out. If the medical attendant with to know, in any cafe, what relation the urine and the drink bear to each other, they request the patient to attend particularly to this circumftance, perhaps for twenty-four hours. In confequence of his attention being directed to the ingefta, he probably takes lefs both of folids and fluids; hence a difproportion appears, by no means ufual, efpecially if the ingefta taken previous to the experiment be overlooked. In hofpital practice, great caution is requifite in drawing any conclufion; fo numerous are the fources of er ΤΟΥ. The feventh and eighth articles of the fummary are the most original, and, if fully eftablifhed, the most important of the whole. From the analyfis of diabetic urine, conducted with great attention, and the refult of every experiment compared with healthy urine, Meffrs Nicolas and Gueudeville have drawn the following inferences: 1, That diabetic urine contains none of that peculiar matter called urée, no uric or benzoic acids, and a very fmall quan tity of phosphoric falts: 2dly, That it pafles readily into a state of fermentation, and contains a large quantity of a peculiar faccharine matter, the nature of which is not yet rightly underftood. It is much to be regretted that our authors have omitted to mention, whether the urine they examined was from one diabetic patient only, or from feveral; because the ufual ingredients of urine, and the relative proportion of them, vary confider bly in different perfons, and even in the fame perfon, at different times. The refult of these experiments feems to fhow, that urée was in very minute quantity, if not wholly deficient in diabetic urine. The prefence of faccharine matter, and the very diluted ftate in which all the falts are found, when urine is fecreted in great abundance, renders it difficult to detect thefe fubftances by the usual tests. Hence, a fmall portion of urée might exift, fufficient to give that peculiar colour and unpleasant fmeil to alcohol, as was obferved, without being fo confiderable as to be detected by cryftallization and by the nitric acid. We are inclined to make this fuppofition, becaufe Ee 4 It because the experiments which we have made, and, ftill more, the numerous and repeated trials made by feveral of our friends, authorife a very different conclufion. In all these experiments made on diabetic urine from different patients, and at different periods, urée has always been detected, and likewife all the fubitances common to healthy urine, only in lefs proportion. The fmall quantity of phofphoric falts may readily be accounted for, in confidering the quantity of fluids taken in and discharged. To question the accuracy of thefe experiments made by a Profeffor of chemistry and a learned phyfician, may be deemed bold and prefumptuous; but if the authority of great names be neceffary to give countenance and credit to any affertion, we could adduce the teftimony of a Profellor of chemistry, and even of two Profeffors, in fupport of what has been just stated. At any rate, it is impoffible to build a legitimate theory of diabetes on the deficiency of urée: 1, because there are numerous inftances of the urine containing urée along with faccharine matter; and, 2uly, because there is one fpecies of the difeafe, where faccharine mat, ter, as well as urée, are almoft wholly deficient in the urine. happens unfortunately for this theory, that the urine in this complaint exifts in fuch oppofite ftates: fometimes it abounds with faccharine matter; at other times, this sweetness cannot be detected, while, at the fame time, the affinity between thefe different ftates is fo great, that they pafs into each other fuddenly, or by infenfible degrees. This variation in the tafte, 'colour, and fmell of urine, occurs very remarkably in the fame patient, when the fyftem is deranged by any febrile attack. In framing expla nations of the proximate caufe of diabetes, authors, in general, feem to have directed their attention folely to the faccharine qualities of the urine, and to have overlooked entirely that fpecies in which the chemical qualities of the urine are quite oppofite. The existence of diabetes infipidus is a fact which cannot be doubted. Now, the nature of this latter complaint, and the refult of nunberlefs trials with animal diet, fhow that the qualities of the urine may be very little altered, its quantity reduced to the healthy ftandard, and yet the emaciation and drynefs of the skin continue, and the patient fall a victim to the difcafe. Hence the axiom which is here laid down, that the return of the urée and photphoric and muriatic falts is a proof of the cure being accomplified, cannot be deemed of any great weight." In conformity to their ideas of the caules of diabetes, Meflrs Nicolas and Gueudeville have propofed their method of cure:to remove the fpafmodic affection, and to afford the principle of animalization to the fyftem. The means employed to fulfil these indications, were not fuch as practitioners in this country would place place much confidence in. Animal diet, phosphate of foda, phofphoric acid in dozes of eight and ten drops, the watery extract of opium, musk, bark, ammonia, and frictions with lard and oily liniments, were the remedies employed in the four cafes which are detailed; and in one cafe, a gentle bleeding preceded this course of treatment. What was formerly called, amongit us, deoxygenating the fyftem, thefe writers term azotifing, which feemed to bear the interpretation of killing the patients; but, to our great astonishment, three out of the four are faid to have been cured in a very short time!-Experience has shown, that the exclufive ufe of animal food is the beft and quickeft mode of relieving the most urgent symptoms of the difeafe; and, in fome cafes, a permanent cure has been effected by this regimen alone. But it would be an unprofitable task to enumerate the numerous and oppofite remedies which have been at one time extolled, and then condemned. The uncertainty which prevails with regard to the causes, has left a wide field open to experiment in the cure; and it is to be feared, that much progrefs will not be made in the one, till our knowledge of the other has been greatly increased. It is true, the pathology of diabetes has not been illuftrated, as à priori might have been expected, by examining appearances after death. No decifive and characteristic morbid changes have been discovered, though there is no reafon for regretting, with our authors, that fo few cafes of diffection are on record. Before concluding this article, we ought not to omit mentioning, that frequent farcafms are caft on Dr Rollo in different parts of the prefent memoir, for not giving the merit of certain opinions and modes of practice to the original inventors. Thus, it is faid, that animal diet was employed by all the old phyficians, while it is forgotten, that an exclufive employment of this diet was the only novelty in Dr Rollo's practice. He is accused of plagiarism in several other particulars. But let us hear thefe advocates for rendering honour unto those to whom honour is due, (or, as they defcribe themselves, admirateurs des anciens autant qu'apotres zélés des découvertes modernes,' p. 33.), involving themfelves in the very crime which they fo feverely condemn. In p. 13. they affert, that Dr Rollo has founded his doctrine on pneumatic chemistry, for which Europe is indebted to France! Again, in p. 37. we are told, that Dr Rollo is indebted to Fourcroy for the notes which embellish his work; and the author of the Syfteme des connoiffances chimiques,' is mentioned as the first person who pointed out the difference between fugar and gum, by experiments made on the germination of feeds. It is fcarcely to be imagined, that neither of thefe gentlemen ever read more than |