gravity 1035°, and on boiling with liquor potassæ, there was unmistakeable evidence of the presence of sugar. I now directed a careful diet; no sugar in any form, no pies or puddings; potatoes to be excluded, and bread and green vegetables to be but sparingly used; malt liquor to be left off, and its place to be supplied by Claret and still Hock. I prescribed the Nitrate of Uranium as in the former case, i. e., five drops of the third decimal dilution three times a day.

The quantity of urine almost immediately fell to its normal average. When I examined the urine again in a week's time, the specific gravity was only 1027°. The thirst was lessened.

The next week's examination disclosed no change, but a fortnight later the specific gravity was only 1019°, and but few traces of sugar were visible. This was in August and September, 1865. The old gentleman has continued hearty since, though somewhat paralytic. He has long ago resumed his usual diet.

Case III. satisfactory.

My third case is still more interesting and

Mr. W, æt. about 25, consulted me on October 2, 1865. I rarely saw any one to whom the term "walking skeleton" might be more justly applied. His history was this. His father had died of diabetes not very long ago; he himself had enjoyed good health until the latter end of May in this year, when he had an attack of rheumatic fever. During convalescence therefrom, imprudence in diet brought on a sharp attack of bowel complaint, which his medical attendant called enteritis. It was immediately after this that sugar was detected in the urine, though he is confident he had had diabetic symptoms for some time before. He was put upon the usual diet at the beginning of July, and had continued it to the present time, but without improvement.

I found, on inquiry, that he was at this time passing about six pints of urine daily. His thirst was great. He was very weak, so that he had to come to my house in a chair. His pulse was 120, and feeble; his tongue and the

mucous membrane of his mouth generally of a bright glazed red. His spirits, however, were good.

I gave a drop of Arsenicum 3 three times a day, and desired him to come again in three days, bringing with him a specimen of his morning urine.

October 5th. He feels stronger somewhat from the Arsenicum. His urine has a specific gravity of 1035°, and contains a large proportion of sugar. To take Nitrate of Uranium thrice daily, as in the former cases. I made no change in his diet, except to substitute for the brandy and water he was taking light wines,-Claret, Sauterne, Chablis, still Hock and Moselle, according to his taste-and an occasional glass of dry Sherry.

9th. The urine is now only five pints daily; otherwise the same.

14th. He feels decidedly better, stronger, and less thirsty. The quantity of urine is now only four and a half pints, and the specific gravity has fallen to 1026°. Being very tired of the bran bread, I introduced Dr. Pavy's almond food to his notice, as an agreeable substitute.

21st. The improvement has continued. The urine is now between three and four pints daily. His pulse has gone down to ninety-three, and he has gained two pounds in weight since the beginning of the treatment. As he was now leaving Brighton, I recommended him to continue the medicine, and write to me from time to time.

November 22nd. He reports that the specific gravity of this morning is only 1022°. His strength continues to improve, and he wishes to know if he may vary his diet. I told him to try a captain's biscuit occasionally by way of bread, and to continue the medicine.

December 13th.-He writes, "I am feeling better, and certainly get stronger every day. I have gained seven and a half pounds since I left Brighton, but I find I sometimes lose a little and then gain again." The specific gravity of the urine, however, was rather higher, varying from 1027° to 1031°.

February 13th.-This day Mr. W-, from whom I had not heard since the last date, came into my study; he had

altered greatly for the better in appearance.

In reply to

my questions, he told me that his general health was vastly better; he could walk two or three miles without fatigue; his weight, last time he got into the scales (January 29), was nine stone two and a half pounds, i. e. thirteen pounds more than when he began treatment; his urine was always below three pints in the twenty-four hours. He brought me a specimen passed that morning; it looked much more like healthy urine, but its specific gravity was 1028°, and the potash test still showed the presence of sugar. I now gave

him the second instead of the third decimal dilution of the Uranium, directing him to take as before five drops thrice daily. He continued the same diet, to which he had become tolerably accustomed.

February 24th.-Mr.W-saw me to-day, as he was leaving Brighton. He continued to improve, and his weight continued at nine stone two and a half pounds; his pulse was 86. The specific gravity he found to vary between 1024° and 1028°; one morning it had been as low as 1022°. To go on with the first dilution of the Nitrate of Uranium, increasing the dose by one drop each week until it reached ten drops. I must leave these cases to the judgment of my colleagues; to my thinking, they prove that in the Nitrate of Uranium we have the nearest approach yet made to the true Homœopathic specific for diabetes. At any rate, it is means at our com

a most valuable addition to the medical mand wherewith to arrest its progress.

ON GOUT AND RHEUMATISM IN CONNEXION WITH LEAD POISONING.

By GEORGE MOORE, M.D.

IN the Medico-Chirurgical Transactions for 1854, vol. xxxvi, page 181, Dr. Garrod draws the attention of the profession to the influence which the impregnation of the human body with lead appears to exercise as a predisposing

cause of gout. He was, he says, struck with the curious fact that at least one in four of the gouty patients who fell under his observation in University College Hospital, had, at some time or other, been affected with lead poisoning, many of them being plumbers and painters. At a later period he returns to a consideration of the same interesting point in his work on Gout,* in which, at page 284, he says that his subsequent observations amongst patients and inquiries amongst the workers in lead have confirmed the correctness of his original statement. He states that painters and plumbers are much more frequently affected with the disease than other operatives in the same station of life, and that no other circumstance beyond their exposure to lead action appears to account for their peculiar liability to gout. Dr. Burrowes and other physicians have likewise observed the great frequency of the disease amongst painters.

Dr. Garrod next inquires if lead impregnation alone, without the help of other predisposing causes, can induce gout; and, replying to his own query, he says he is not prepared to answer in the affirmative, although he would hesitate to deny the power of the metal of itself occasionally to bring on gout.

Assuming that the presence of lead in the body confers a strong predisposition to gout, he proceeds to ascertain how it so acts. He examined the blood and urine of seven patients suffering from lead poisoning, and also the effect produced on the secretion of uric acid when lead was administered medicinally to two individuals. The results of the examination seem to show that lead causes the blood to become loaded with uric acid, not so much from an increased formation of it in the system as from its imperfect excretion by the kidneys. It is to be remarked that in two cases, if not in a third also, no traces of uric acid could be discovered in the blood, although the patients were undoubtedly suffering from lead poisoning, and that out of the six cases detailed, three "never had gout," one had “slight threatenings," one had "slight attacks," and

* The Nature and Treatment of Gout and Rheumatic Gout, 1859.

another had "no gout till after his admission into the hospital."

However correct Dr. Garrod's theory of gout may be, namely, that the disease arises from redundance of uric acid in the blood, consequent upon its excessive formation or deficient excretion, I do not think that it gains much, if any, support from the few and contradictory facts which he himself brings forward with respect to the action of lead.

In the Edinburgh Medical Journal for August, 1862, Dr. Warburton Begbie follows in Dr. Garrod's wake. He gives the notes of two interesting cases. Case 1 had characteristic gum stain, colic, paralysis, muscular wasting, and epileptiform seizures. Whilst under treatment with Iodide of Potassium, he was attacked with severe pain in the ball of the right great toe and right ankle-joint, accompanied by swelling and redness of the surface. He had previously suffered from three distinct attacks of a similar kind. He continued to improve up to the twenty-fourth day of treatment, when he felt pain in the joints of his arms and legs, and an exocardial bruit was detected. He was reported well a month later. Case 2, also a house painter, and, like the other patient, fond of his beer, had lead colic, and also "pains which he calls rheumatic, in the head, shoulders, and limbs." Treatment ceased on the eighth day, when the patient was "still feeling his rheumatic pains." Dr. Begbie remarks that this case "may be regarded as an apt example of cases which, to the amount of nearly a dozen, have fallen under my observation during the last seven years, cases of lead colic, the sufferers from which have always complained of pains either in the limbs generally or in particular joints." He refers to another case of a house-painter, who, after "much complaint of flying pains through the limbs for many weeks," was seized with a very severe attack of rheumatic endo-pericarditis, which left an insufficient mitral and an adherent pericardium. Dr. Begbie accounts for the comparative infrequency of gout amongst the operative classes in Edinburgh, by the addiction of the Edinburgh workmen to. distilled liquors, and of the London men to fermented