On the 23rd, Mr. Moore learnt for the first time, and with no little surprise, that Mr. Forrester and the two inspectors, who constituted a "medical committee" on behalf of the Norwich Association-had, without his knowledge or consent, taken Mr. Robert Moore to nine other cases, five of which they refused to register, one they wished him to treat although it was fast dying, and did die eight hours afterwards, and three which, although very far advanced, he thought best to give a chance of recovering. Mr. Moore himself is made responsible for all this. I repeat, he prescribed once for twenty-two cases in all, and not for sixty, as the speech inaccurately and unintentionally represents ; thirteen of these cases he pronounced all but hopeless at the time; two out of the twenty-two recovered, a very fair percentage in such bad cases; he repudiates what was done on November 23rd; and he declares that not one of these cases was under his "care," or was systematically treated by him at all, as the veracious Lancet states. A full account of the matter has been sent in to the London Cattle Plague Association, and an abstract to the Royal Commission. Mr. Moore has likewise addressed an explanatory letter to the Lancet, asking its insertion in accordance with the practice of every fair and impartial journal. Whether it will appear, or not, remains to be seen. I have a few more words to say before putting a period to this paper. After reading a good deal about cattle plagues, ancient and modern, in foreign and native works, and personally investigating to some extent the prevailing one, my opinion as a physician is clearly this, that we should take care not to over-estimate the powers of mere medicine, whether allopathic or homeopathic. The cow has a peculiar constitution; her diseases are prone to assume a low type; and even in the most seemingly favorable cases, death comes on suddenly. Relapses are easily provoked and almost invariably fatal. She requires to be nursed with the greatest care and watchfulness, as respects food of suitable kinds and quantity, to be well housed, and warmly clad. I know that in many cases, after the most severe symptoms have been kept under by homoeopathic medicines, death has ensued from some idiotic clodhopper disobeying orders as to diet, and giving to an animal with returning appetite-the surest sign of convalescence-what its weak paunch could not digest and prepare for rumination. I am convinced that justice cannot be done to any treatment, allopathic or homœopathic, unless the most anxious attention be paid to hygiène—a view which it is simply impossible to drive into the heads of the bulk of farmers. Human practitioners have but an imperfect conception of the insurmountable difficulties met with in the successful prosecution of veterinary practice; and, speaking for myself, I am not disposed to accept the results of any treatment whatever, as expressive of the influence of science and art over this disease, that are not obtained by feeding the patients properly, by giving the medicines regularly, by preventing the possibility of reinfection during convalescence (?) and by providing means of shelter. All these matters can only, I fear, be thoroughly attended to, as is done at Edinburgh, in hospitals, with professional superintendents, and a staff of trustworthy subordinates. These remarks are suggested by information respecting the experiments now going on in Norfolk, where, on one farm, convalescent animals relapsed and died because no food could be got for them, except uncooked turnips. Physic cannot take the place of food. It is a poor satisfaction to cure the plague by homœopathy, and to lose the patients by improper dieting. ON DIABETES; ITS PATHOLOGY AND By RICHARD HUGHES, M.R.C.S., L.R.C.P., ED. (Exam.). It will be my object in the following paper to take stock, so to speak, of our present knowledge concerning the disease called diabetes: to present the latest results of investigations into its pathology, and to estimate our resources for its treatment. The subject has lately been treated of at some length by Dr. Harley, in lectures published in the Medical Times and Gazette. I shall follow his footsteps pretty closely in the pathological portion at any rate of the discussion. I begin by laying him under contribution for a brief sketch of the history of our knowledge of this disease. "From time immemorial, cases of emaciation, accompanied by an inordinate thirst and voracious appetite, had been observed; and in consequence of the patients so affected being at the same time troubled with an excessive diminution of urine, ancient physicians gave to the disease the name diabetes (día, Baivw). It was not, however, until 1674 that the urine was discovered to possess, in some cases, a sweet taste, the honour of which discovery belongs to an English physician, named Thomas Willis. From this time henceforth, the disease was divided into two classes, one of which received the name of diabetes insipidus (without sugar), the other that of diabetes mellitus (with sugar)." The former is now known as chronic diuresis, and separated altogether from the true diabetes. "In 1774, Matthew Dobson, a physician practising in Liverpool, discovered that the blood as well as the urine in diabetes contains sugar, and, from this observation, he justly concluded that the saccharine matter found in the urine is not formed in, but only excreted by, the kidneys. "In 1778, Cowley succeeded in separating the sugar from the urine in a free state. "In 1776, John Rollo, surgeon-general to the Royal Artillery, made the first important observation regarding the treatment of diabetes by discovering that an animal diet not only reduces the quantity of urine, but even diminishes the amount of sugar daily eliminated. "The next two steps were made by foreigners. "In 1815, M. Chevreul ascertained that the saccharine matter met with in diabetic urine differs from ordinary cane sugar, and closely resembles that of the grape. "In 1825, another important step was gained by Tiede mann and Gmelin discovering that starch is transformed into sugar during its passage along the alimentary canal. "In 1837, the next observation of interest was made by Macgregor, of Glasgow, who found sugar in the vomited matters of diabetic patients-an observation which seemed to confirm Rollo's idea that the disease arises from the gastric juice turning vegetable food into sugar; and from that time to the present animal diet was consequently considered our sheet-anchor. "We now arrive at an entirely new phase in the literature of diabetes, in which the teachings of the sick chamber gave place to those of the laboratory. "In 1848, the physiological world seemed as if struck by a thunderbolt when Bernard proclaimed that animals, as well as vegetables, had a sugar-creating power. Until then, all the saccharine matter met with in the human body, whether in health or in disease, was supposed to originate in the transformation of vegetable substances. And now, for the first time, were we made alive to the startling fact that men, like sugar canes, possess within themselves a saccharine manufactory; the liver being daily and hourly as actively engaged in fabricating sugar as in secreting bile. "In 1849, Bernard discovered further that the disease can be artificially communicated to animals by pricking the floor of the fourth cerebral ventricle. "In 1853, I discovered that diabetes may be artificially induced in animals by exciting the liver through means of stimulants, such as alcohol, directly introduced into the portal circulation. An observation which explains the wellknown fact that diabetes is a much more common disease in spirit drinking than in other countries. "In 1855, Bernard discovered that the formation of sugar in the liver cannot be regarded in the light of a "vital" process, as it goes on, not only after the death of the animal, but even after the removal of the liver from the body. "In 1856-7, Chauveau and myself gained another piece of ground by ascertaining that the sugar normally present in the circulation is not burned off in the lungs, as hitherto supposed, but disappears from the blood in its transit through the capillaries of the general circulation. The function of the saccharine matter most probably being to nourish the body. "In 1857, Bernard made the additional discovery, that before albuminous substances are converted into sugar, they first pass throngh the transitional stage of "glucogene" (animal starch). "Lastly, in 1859-60, Brücke and Jones ascertained, by careful experiment, that traces of sugar are even to be detected in normal urine, an observation which, as we shall afterwards see, has an important bearing on the pathology of diabetes; for it may be regarded as a fundamental law that in disease neither new substances nor new functions are created. Morbid phenomena are merely the result of a change in the quantity and quality of normally existing agents and agencies." I would add that if any one desires to follow out Bernard's researches in detail, he will find an account of them by Dr. Russell, in his own admirable style, in the 15th volume of this Journal. The results of the discoveries above narrated may be classed under the heads of chemistry, physiology, pathology and therapeutics. Chemistry. The chief point of chemical interest about diabetes is the kind of sugar excreted. There are two leading forms of saccharine matter, of which cane and grape sugar are the respective types. The former are easily crystallised, are undecomposed when boiled with an alkali, but are changed by acids into a sugar of the second class. The latter are not easily crystallised; when boiled with an alkali are transformed into glucic and melassic acids (giving the well-known claret colour and treacly odour); and are unaffected by acids. Diabetic sugar belongs to the second class and so also does the sugar which is normally formed by the liver. Whether, however, these two are absolutely identical is not yet certain. Berthelot and De Luca (as quoted by Dr. Harley) answer the question in the affirmative; but Drs. Owen Rees and Pavy in this country maintain a contrary : |