as "Parkes and Leubuscher found pepsin useless," go for very little, and must not deter practitioners from prescribing pepsin in cases where the digestive power of the stomach is impaired. This remedy is not only of real service, but it gives comfort to the patient, and not unfrequently relieves pain and distress.

Alkaline remedies are of advantage if given from time to time. They probably promote the removal of the sugar already formed in the blood, and perhaps help assimilation. Small doses of liquor potassæ (ten drops to an ounce of water), or ten-grain doses of bicarbonate of potash or soda' after food, or two or three tumblers of Vals or Vichy water with the meals daily, for a week or ten days at a time, may be given in cases where the urine is very acid or the patient troubled with flatulence and discomfort, lasting for some time after a meal.

Constipation is often very troublesome in diabetes, and even in those cases in which the appetite is not inordinate, the quantity of material excreted into the large intestine is very considerable. The formation of sugar is associated with the formation and accumulation in the blood of considerable quanties of those substances which constitute the chief constituents of the fæces, and which are separated by the glands of the lower part of the small intestine and the large bowel. In cases of diabetes, the separation by the kidneys of an undue amount of water promotes active absorption by the mucous membrane of the colon and cæcum. Consequently the fecal matter quickly becomes inspissated, and not unfrequently hard and almost dry. Far too little fluid is secreted by the glands of the large bowel. The nerves and nerve centres being also sluggish, accumulation goes on to a great extent in some cases without any reflex action being excited. Sometimes frequent injections are required before any relief can be obtained. It is necessary, in managing a case of diabetes, to guard against this contingency by frequently giving purgative medicines. Aloes, scammony, colocynth or compound rhubarb pill generally answer, but it is necessary to change the purgative from time to time. The tincture of Cascara sagrada, or the so-called Cascara cordial, seems to be a valuable addition to our purgative remedies. It usually

N*

operates gently without producing pain. From fifteen to twenty or thirty drops in a tablespoonful of water may be taken over night, and the dose is generally followed on the following morning by a pretty free action of the bowels. A syrup of the cascara bark is now prepared, the taste of which is not unpleasant.

If

Of the usefulness of opium in the treatment of diabetes, there is no doubt. It not only causes a reduction in the daily secretion of sugar, but the quantity of water passed is lessened. the patient is restless and irritable, he is benefited by the soothing effects of the drug upon the nervous system. In many cases, so far from increasing the constipation, which is so frequently troublesome, opium seems to have an opposite effect. It must, however, be admitted that now and then a patient for whom opium is prescribed finds that he cannot take it, in consequence of the headache that is occasioned by its use, while sometimes it seems to have little effect upon the water, but seriously disturbs the stomach and increases the dryness of the mouth which is so distressing to the patient. If opium acts favorably, it may be given in half grain or grain doses once or twice a day. The dose should be only increased very gradually. If the patient improves, the quantity may be reduced or the drug withheld for a time. It has been recommended that opium should be given at once in doses sufficient to occasion its physiological effects, but I cannot agree with this advice. Sometimes so little influence is observable, that to produce contraction of the pupils, we might have to prescribe a quantity of the drug so considerable that there would be danger of its toxic effect, suddenly being manifested, and great danger to life might result.

Codeia is preferred by Dr. Pavy, who prescribes this alkaloid in gradually increasing doses, beginning with half a grain twice or three times daily, until, in the course of a fortnight or so, the dose reaches two or three grains.

Cinchonine, quinine and strychnine are unquestionably beneficial in cases in which the disease has not reached a very serious state of development. Such medicines improve the general health and strength, and I have no doubt by their administration the duration of life in many cases may be prolonged and

the distressing feeling of lassitude and exhaustion experienced by many may be mitigated or removed.

I have found carbonate of ammonia (five to ten grains in an ounce or two ounces of water every two or three hours) and liquor ammonia of use in checking the feeling of depression and exhaustion from which people often suffer in this disease. The ordinary compound spirits of ammonia or sal volatile may also be given in drachm or half drachm doses, in a wineglassful of water, once in three or four hours. In those cases of diabetes which are not uncommon in well-nourished, nervous, over-energetic men of from forty to fifty, who have worked too hard and been over-anxious, and have, perhaps, indulged in eating and drinking, with possibly enlarged liver and perhaps albumen in the urine, very great advantage has sometimes resulted from the washing-out system. Such cases often greatly improve, if, before the condition has existed for a considerable time, they spend two months in Carlsbad. At times of the year when that watering-place could not be visited, good effects may be obtained by carrying out a similar system at Bath, some sulphate of soda being added to the Bath waters. Of all the forms of diabetes, these cases, if treated during the early period of the condition, receive the greatest benefit from judicious treatment. If we cannot render the water free from sugar, we may greatly prolong the patient's life if only he will allow himself to be kept to a rational system of diet for a sufficient time. Not only so, but I feel confident that some of these cases which, if left alone, would end fatally in two or three years, may be so far relieved that life may go on to the ordinary period.

Alkapton.-Bödecker found in the urine of a patient a substance which possessed many of the reactions of sugar. Alkapton is of a pale yellow color and does not crystallize. It contains a large quantity of nitrogen. It reduces copper, like sugar, but does not reduce oxide of bismuth, nor is fermentation excited in it by yeast. Urine containing it becomes of a brown color upon exposure to the air, if an alkali be present, without the application of heat. This change occurs if potash be added. Sugar and potash change color only when the solution is boiled.

Alkapton was separated by Bödecker from the urine by the following process: After precipitation with acetate of lead, the mixture was filtered, and the solution mixed with tribasic acetate of lead, excess being avoided. The precipitate was washed, suspended in water, and decomposed by sulphuretted hydrogen. The solution filtered from the sulphuret of lead was evaporated to dryness over the water bath, and the residue extracted with ether. The alkapton remained after the ether had evaporated. (Bödecker: "Zeitschrift. f. Rạt. Med." VII, 128; “Ann. Ch. Pharm." Jan., 1861; Bowman's "Medical Chemistry," edited by Prof. Bloxam, p. 51.) Alkapton was found in the urine of an infant by Dr. Johnson, his attention being called to it by the brown stain on the linen (quoted in Bowman's "Med. Chem." by Bloxam, p. 52.)

ON URINARY CALCULI AND CALCULOUS DISORDERS.

There are several substances in healthy urine which are only slightly soluble in water. In certain derangements of the physiological actions, some of these are produced in much larger proportion than in health, while other matters not present in healthy urine, and not readily soluble in water, are sometimes formed. It is not, therefore, surprising that, from time to time, some of these not very soluble substances should be slowly deposited in the insoluble form from the urine while it yet remains in the bladder, or even before it reaches that organ. It is interesting to consider the various conditions which are likely to lead to the deposition of calculous material, and it is instructive to study the general state of the system which is associated with each particular form of insoluble matter deposited. If we were accurately acquainted with the mode of deposition of calculous matter, it is very possible that we might lay down such rules for the guidance of patients in whom the tendency existed as would prevent the formation of the stone, or retard its increase if already formed.

The deposition of a calculus does not always depend upon the state of the urine, for it is possible that the urine may be healthy while a stone is forming; the changes taking place on the surface of the stone itself having much to do with the precipitation of insoluble matter. These changes are different in different cases, sometimes resulting in the setting free of an acid and sometimes of an alkali. Bacteria are intimately concerned in the initiation and maintenance of these changes. It will often be found that the tendency to calculous disorder is explained by deranged chemical changes, which may perhaps sometimes be materially modified by giving attention to the action of the