was derived from the food and stored in the liver, and while ordinarily it was burned off in the lungs, it was converted into fat. In abnormal cases it was converted into sugar and expelled by the kidneys. Since then numerous theories have been advanced, but they all contain the essential nucleus first set forth by Bernard. The truth is, that sugar is a normal constituent of the blood and tissues, elaborated by the liver from the food products, but if from any cause more sugar is formed than is needed by the system, the excess is eliminated through the urine. The point of sugar saturation, so to speak, in man is not known, but in the dog it is from one-fourth to one-third of one per cent. That the sugar comes from the hydro-carbons of the food is certain, whether it ever comes from fats and proteids is not yet positively determined. That it is elaborated by the liver and is one of its normal productions is likewise established, but what the immediate cause is which stimulates the hepatic cells to elaborate more than is required is not known. There are probably many causes which may do this. We know that cerebral lesions or irritation may do it. We know that poisoning by curare, carbonic oxide, nitrite of amyle, and other drugs which paralyze the vasa motor apparatus of the liver, will cause it. We also know that long-continued over-stimulation of the hepatic cells by blood richly laden by food products, will occasion it. There is no doubt that a permanent dilatation of the hepatic capillaries exists in this affection, and that the entire organ is in a state of chronic hyperæmia. Rockitansky indeed found the liver enlarged, hard, and brown, or otherwise changed in over fifty per cent. of the cases he examined. But whatever the precise sugar-making process may be, there is no other affection, with the exception of scurvy perhaps, which we can so effectually control as this. It is true we may not be able to cure our patient, but we can confidently promise relief and a lengthened lease of life. And I need hardly tell you that our only reliance is on food and diet. If the sufferer will follow a rigid, cast iron system of diet he is safe, for years perhaps; if he abandons it, and seeks relief in drugs and nostrums he is lost. The diet should be remorselessly shorn of everything containing sugar and starch. It should consist of albumenoids, and such vegetables and other articles as cannot be converted into sugar. To those who have occasion to consult a diet list suitable for diabetics, will find the one Dr. Flint published in the Journal of the American Medical Association, July 12, 1884, very satisfactory. The last affection I propose to consider is corpulency. This condition was recognized even by by the ancients as a disease, and Hippocrates himself gives a course of treatment hardly inferior to that of the celebrated Dr. Harvey. Fat men were particularly offensive to the æsthetic eyes of the ancient Greeks, and measures to repress them became matters of State hygiene. With us moderns the case stands differently. We are more concerned with the soul than the body, so that the latter has to shift for itself. With us, fat men stand on an equal footing with lean ones. In fact, I am not sure but that they fare better, as a rule, than their thin brethren. For instance, are they not victorious in all games of strength and skill, such as base ball games and foot races, to say nothing of the race of matrimony? But seriously, the study of corpulency is of great interest, because in investigating its pathology we at the same time are delving into the very foundation of nutrition and food metamorphosis. Not long ago we were taught to believe that the fat of our bodies came directly from the fats and hydro-carbons which were contained in the food. But now we are told that this theory must go into the limbo for all improved theories. We must now believe that our store of fat comes only from the albumenoids and homologous fats, and that the hydro-carbons and heterologous fats only indirectly assist in the process. But dropping all fine spun theories, the fact is obvious that the fat store comes somehow from the food and drink which is consumed, and that we have it in our power to increase or diminish our fat disposition. And yet we must admit that the predisposition to corpulency is inherited. We know also that fat accumula tion is formed by the use of alcohol, especially in the shape of malt liquors, by sedentary habits, by sex, and by sleep, and other psychological influences. And we know further that it is diminished by a frugal diet, by home labor, loss of sleep, and by the play of consuming passions. Knowing all this as we do, we are in position to answer intelligently, I think, the questions so often asked us. "Doctor, what shall I do to get fatter?" or, "Doctor, what must I do to get leaner?" I have not space enough at my disposal to enter into lengthy details, but the treatment is by food and diet, assisted by other agencies. The plan laid down by Dr. Harvey for the since celebrated Mr. Banting, is, perhaps, the most rational and practical at our command. The latter gentleman, after a vain search among many eminent medical men for a relief of his corpulency, finally went to Dr. Harvey who laid down a system of diet which was wonderfully successful. Mr. Banting, from gratitude and sympathy for other sufferers, published the plan of treatment in a little pamphlet, and the system has since been known as the Banting system for reducing corpulency. I have tried it in a few cases with very satisfactory results. I refer you to this pamphlet for the details of the treatment. I have now gone over the ground which I have proposed to cover in this paper, and although I might show, did time permit, that the principle here advocated might be rationally and successfully applied in many other pathological conditions besides the ones I have mentioned. In phthisis, scrofula, anæmia, rheumatism, gout, fevers, and inflammatory affections of all kinds, and a host of simpler and lesser affections, from whose sum total humanity suffers more of woe than it does from the most fatal epidemics, a properly selected regimen contains a potentiality for good, transcending all drugs. But I beg of you not to misunderstand me. I am not flattering myself that I have made a new discovery, and I am not preaching a crusade against drugs. The value of food and diet has been known since medicine had its birth, and the value of drugs cannot be too highly prized. But I do maintain that food and diet are too little appreciated, and that the value of drugs in disease is exaggerated, and that they are too often unnecessarily given. I stated a while ago, when touching on this point, that there was still another reason why drugs held such an exalted position in the treatment of disease. I will now state it, but I greatly fear it is to our professional discredit. We, as a profession, undoubtedly pander too often, both against our reason and conscience to the popular prejudice, or, perhaps, I might say, to the popular mania for drug taking; and, what is still worse, we do it for the sake of miserable gain. We lack the moral courage, to say to our patients, "You do not require any drugs in this case, but go and do so and so, and you will be whole," and then we are too cowardly to charge for the good advice. We undervalue the highest part of our attainments, our special education, our educated touch, our painfully acquired skill and knowledge, and our ripened judgement, and we set a price on the miserable drug, which is only our slave. But as long as the practice of medicine is regarded simply as a trade, an industry, or an invest ment, so long, I fear, will the workman be confounded with his tools, and the doctor, with the drug store attachmet, will stand the highest in popular favor and esteem. CONSANGUINITY IN MARRIAGE. Conclusions from a Paper read before the Ohio State Medical Society, at By E. S. McKEE, M.D., Cincinnati. CONCLUSIONS: 1. Like breeds like, good or bad, entirely independent of consanguinity. 2. Evil results have undoubtedly followed consanguineous marriages, but whether dependent upon consanguinity is extremely doubtful. 3. Intemperance, luxury, dissipation, sloth and shiftlessness, as well as hygienic surroundings and innumerable other causes, among them the depraved moral state dependent on births the result of incest, should bear much of the responsibility laid at the door of consanguinity. 4. Testimony is often weakened by religious or other prejudices. 5. Data are of doubtful reliability, full of flaws and false reasoning. The noted cases are the unfortunate ones. The favorable are unknown or forgotten. It is the ill news which travels fast and far. 6. We, as physicians, know that there is much more illicit intercourse than is generally supposed. May not many people be related though not aware of it? Many marriages may thus occur between relatives presumed to be no relatives, thus again vitiating statistics. 7. Statistics show about the same proportion of deaf mutes, idiots and insane persons descendent from consanguineous marriages to the whole number of these unfortunates as the number of consanguineous marriages is to the whole number of marriages. They show fertility among the consanguineous to be slightly greater than among non-consanguineous. They also show a somewhat greater frequency of retinitis pigmenteæ. 8. Atavism explains fully the fact that in some instances healthy consanguineous parents beget unhealthy children. This, as is well known, occurs in most hereditary troubles. Furthermore, a less superficial examination may show this healthfulness to be only apparent. 9. Evil results in the offspring of consanguineous marriages proves that something was wrong. That it was the consanguinity has not been proven. It may have been one of a hundred things and dependent on all of the antecedents for generations. Such results remaining absent after these marriages proves, for that case at least, that consanguinity was harmless for it was known to be present. Further, if consanguinity was the cause, the effect should follow where the cause is present. 10. Consanguineous marriages which bring together persons having a disease or morbid tendency in common are dangerous to the offspring. Not, however, one whit more so than the marriage of any other two persons not related, yet having an equal amount of tendency to disease in common. Conditions present in both parents, good or bad, are simply augmented. and the result would have been the same were they not related. II. Given a malformation or disease firmly established we have a tendency to breed true. Given a defect or peculiarity in a family, race or sect, this will naturally be propagated by inter-marriage; e.g., color blindness is remarkably hereditary among the Jews and Quakers. The Quakers are educated to abhor color. Those who admire color separate themselves from the sect and thus intensify the tendency in the remainder. The defect has probably crept among the Jews and is kept up and intensified by inter-marriage. The same means has had its effect among the Quakers. 12. Certain inherited diseases as scrofula, phthisis and rachitis which are ascribed to consanguineous marriages, probably in every instance could be traced back to an ancestor. 13. Man is an animal, anatomically, physiologically and sexually. He is subject to the same laws of propagation. In and in breeding in animals is carried on to an extent not only not permissible in the human species, on moral grounds, but also beyond the bounds of human possibility. Yet this is done by cunning breeders to improve the stock and put money into their pockets. The Jersey cattle have been bred for the last 150 years on a small island 6 x 11 miles. You would not raise them for beef or oxen, |