it was about to break out anew.

But the application of poultices dissipated the inflammation, and I had no farther trouble from it. I had been subject to frequent and profuse "nose-bleed" from early life, especially in warm weather, but for some months before the time I now date the commencement of my illness, (June 1842,) I had none of it; and excepting a few turns of it in July following, I had none, nor has it recurred so frequently since as formerly. In June, 1832, I was preparing for the heavy work of summer, haying, &c., and though I labored hard daily, and my appetite was never better, I was, nevertheless, unhappy; my hired men provoked me, and we quarrelled-there was not (so I thought) the usual care and order in my domestic concerns, and I found much fault. I cannot describe my ill-feelings, and I had no assignable cause for them; I was easy and prosperous in my circumstances, and had always been happy in my domestic relations. So went on the months of July and August. My appetite was great, and my thirst inordinate. I often drank in such quantities that the stomach rejected it. In all this time I continued to labor, though it was obvious to myself that I was losing flesh and strength daily. I tired soon, my skin was harsh and dry, (very unusual) and my bowels were constipated, seldom moving oftener than once in five or six days. It was not until September that I became aware of passing an unusual quantity of urine, and my attention was particularly attracted by a singular deposit where some drops fell on my dress. I examined this and found it to be sweet as sugar; this surprised me, and yielding to the remonstrances of my family, I consulted Dr. Ives. It was past the middle of September when I came under the care of Dr. Ives and yourself. I am now, (after three years) as fleshy as I ever was, and as able to labor as most farmers of my age. If I am vexed or perplexed and have a sleepless night or two, I am certain to have discharges of honied urine, with great thirst. But a hot salt water bath and a cathartic restores me; so that I seldom trouble my friends or the doctor. You will allow me to add that the greatest harmony prevails in my family, and my hired men find no fault with me."

Many, if not most of the leading symptoms in Diabetes Mellitus, can be accounted for in no other way than on the supposition of a disordered Brain. It may be ascertained too, always, probably, that for a longer or shorter time previous to the occurrence or development of diabetic symp toms, there has existed evidence of disordered functions of the Brain; and afterward, in the progress of the disease, it will be observed that the patient becomes morally obtuse, stolid, fatuous, and at length, dies comatose, apoplectic; and finally, that Post Mortem examination discloses no sufficient cause of death, except it be the unnatural condition of the Brain.

In 1843, Mr. S., aged 25 years, after languishing a year and a half, died of Diabetes Mellitus. The circnmstances of the case were briefly these. Mr. S. left the labors of a farm in Massachusetts, and was employed two years as an assistant teacher in an Academy in Virginia. On his return from Virginia he resumed his farming; it was not long, however, after his return, before it was apparent that he had undergone a great moral change. Instead of the mild, good-natured, and retiring young man that he was he had become irritable, irascible, boisterous, and peremptory. "It seems," said his good mother to me, "as though William

was crazy." It was after this time, and not until it was discovered that he passed an unusual quantity of urine, that he came under my notice and care. My opportunities of seeing Mr. S. daily, as it were, from the time he came under my care, together with the P. Mortem examination, (which will be given below,) led to the views I entertain of the cause of Diabetes Mellitus, as I have succinctly stated them in introducing this case. The Post Mortem examination of Mr. S. was made with care, and in presence of several medical gentlemen who witnessed what I am about to state. The body was greatly emaciated, a picture of famine and attenuation, and quite bloodless. The organs of the Pelvis, Abdomen, and Chest except a few open tubercles in the apex of one lung, apparently of recent origin, were sound; they had undergone no visible structural change. The Brain, on free exposure, showed at sight, no trace of previous or present disease. The membranes were remarkably white, pellucid and dry. On separating the lobes, the ventricles, also, were found empty and dry. The Brain itself-the mass, resembled its model in Plaster; it was white, firm, hard, and solid, to a degree we had never witnessed before; when cut into, it reminded us of the strumous mamma and testes; and the resemblance was so striking, that the question arose then, whether the change in the substance of the Brain might not have arisen from a similar cause or causes, (be they what they may) that produce analogous changes in the glands referred to.

I take occasion to remark here, that some weeks before the death of Mr. S., when he had become very stupid and senseless, and finally comatose, his urine diminished to much less than the natural quantity, and instead of the sweet and honied taste, it was pungently acid; like drops of Sulphuric Acid in water.

Circumstances antecedent and present, determined our treatment of Mr. Rogers. It consisted in general blood-letting, and topical about the head; and by puncturing the septum now and then, we succeeded, measurably, in restoring the habitual hemorrhage from the nose. He took small doses of calomel and opium at intervals, for some time, interposing cathartics as they were required. The capillary circulation was promoted by general baths of salted water, at, or above 100°; foot-baths with mustard, blisters, &c., &c. He was enjoined a regular diet, though a particular or select one was not insisted on. It consisted of plain, substantial animal and farinaceous food, morning and noon, interdicting all food and drink except at the prescribed periods. After eating, his drink was hot tea-ad

libitum.

Mr. R. was a man of sense, of sound mind and firm of purpose, and when he was made acquainted with our views of his case, and with our proposed plan of treatment, he submitted himself unreservedly; and by scrupulously guarding against exciting causes, and manfully resisting his sickly craving, he contributed, no doubt, essentially to his cure. F.

The subject of the foregoing communication possesses much pathological interest and practical importance. Modern Pathology has advanced our knowledge of Diabetes vastly, since the time, within the recollection of those of us who are still junior members of the profession, when it was regarded as a renal disease. Recent researches, which have led to a better knowledge of the changes which the alimentary

supplies undergo during the process of assimilation, and of the function of secretion, have enabled us to perceive that the presence of Sugar in the urine of diabetic patients, is the result of a deficiency of that converting power, (to quote the term used by Dr. Prout,) by which Sugar, amylaceous and other substances of the aliment, or the separated portions of the organism, are changed into organic products, fitted for the nutritive and other normal functions. Owing to this deficiency of converting power, the Sugar contained in the aliment enters the blood vessels unchanged, and the farina, and other substances, obeying their chemical tendencies, pass into the form of saccharine matter. The Sugar thus exists in the blood, and the only part which the kidneys perform, is to separate it from this fluid. The disease, therefore, has been ascertained to consist (in so far as the development of sugar is concerned) in mal-assimilation, not in mal-secretion. We have thus made great progress in the investigation of this disease; but we have only reached a secondary stage in the investigation. The true proximate cause of the disease is ulterior to the introduction and formation of sugar in the blood. Whence is derived the absence of the normal converting power? This question remains to be answered. It is with reference to this question that the views presented in the foregoing communication have especial interest. May it not be, that this deficiency of converting power, or in other words, this mal-assimilation, to which our investigations have carried us, is, in fact, the consequence of a pre-existing affection of the nervous system? The affirmative to this inquiry is invested with much plausibility from the fact, that in the present state of our knowledge, we must attribute the prime source of all the vital functions to the vis nervosa - the assimilatory among the rest. The two cases which our correspondent details are highly interesting and important in this connection. That the disease stands in certain close relations with a disordered condition of the nervous system, these, and other cases, sufficiently attest. But, whether in these relations the diabetic affection be first or second in the order of sequence, or whether both are effects of the same, unknown, ulterior, pathological condition, remains to be definitively settled by future researches. The subject commends itself to, and we trust will receive the attention of practical observers and pathologists.

Our correspondent, who chooses to withold his name, promises to contribute other papers, as his leisure and inclination allow, on topics which may present themselves on a retrospection of forty years of active professional experience. To express, in behalf of the Journal, our sense of the value of such communications, would be superfluous. It were much to be desired, that practical members of our profession, after long experience, would publish oftener than they do, the important facts, and the prominent views which appertain to their observations and reflections; and we shall be truly glad if our Journal may contribute to any extent to promote this desirable object. An Autobiography of a Physician of forty or more years of active service, which would embrace an account of the anxieties, difficulties, mortifications, temptations, and peculiar trials pertaining to his medical career, as well as the results of his observations and meditations on medical topics; and more than all, which would communicate an honest confession of his false steps, and blunders, as well as his success, would be one of the most entertaining and instructive books which could be written. Whoever, possessing the proper qualifications, will write such a book, will add to the useful labors of the most useful of callings, a legacy of great value to those who are following, and are to follow in his footsteps.-EDITOR.

Cases of Local Irritation, from the Presence of Extraneous

Substances.

Communicated for the Buffalo Medical Journal, by WM. TREAT, M. D.

MR. EDITOR: :- If the following cases should be deemed of sufficient interest to serve the purposes of your Journal, they are at your disposal. Foreign substance in the eye-R. N. age twenty-five, house carpenter, of good habits and constitution, was visited on the 4th Feb., 1844. I learned that on the 12th January while engaged in turkey-shooting, after a round of unsuccessful shots, it again became his turn, when, on the discharge of his rifle, a "blur" passed over his right eye, accompanied with no sensation of pain or other inconvenience, save this blur was sufficient to induce him to speak of it immediately to his companions, and call attention from the object of his sports, a successful shot and dead turkey. After some little delay he called upon a Physician in the vicinity, who, on examination with a microscope, diagnosed incision of the cornea, presumed to have been by the percussion cap; the agent was thought to have passed without the eye as it could not be seen, and for prognosis it was thought possible that the pupilary margin might become irregularly shaped. The remedies prescribed not preventing active inflammation, the patient was induced by friends to consult an itinerant oculist, then in the city, who resorted to mercurials; and the patient at this inclement season was in the habit of walking a mile to visit the Doctor,' while under profuse salivation. This course did not improve the original malady.

With this, the history, I found on examination chemosis, so that a large portion of the cornea was covered by the projecting conjunctiva, and the visible portion with injected vessels extending over it, and its structure marbled-opake. He was subjected to V. S., cathartics, restricted diet, and a darkened room, with ung. Belladonna to the brow. The inflammation was soon removed except a pink, sclerotic, marginal zone around the cornea. 14th February, a superficial ulcer appears upon the surface of the continuedly opake cornea, which was healed by the 4th of March.

26th March Patient is severedly attacked with symptoms of internal opthalmia, which alternately were relieved and re-appeared, until the 20th May, when they finally disappeared, with now marked diminution of the globe of the eye. Pain complained of, much resembling that, as described, from dislocation of the lens. Traces of the pink zone around the eye continued.

Every few months the patient returned to me from his labor, complaining of great sensitiveness of the globe, orbital pain, and slight conjunctival inflammation, which were readily subdued.

On the 25th June, 1845, he had a return of these attacks, more serious than before, for which I resorted to V. S. 3 xxii, nauseants, with low diet, &c., under which the symptoms subsided, and the patient so far recovered as to walk in procession of the 3d July.

4th July There was a slight recurrence of symptoms. On the 5th I saw him. The cornea presented in its centre, a slightly transparent, pin-head like projection as though by pointing of an abscess. As vision was lost before my first visit, and had not returned, and there was now

certainly no hope for it, and the globe was not sufficiently contracted to admit of the insertion of an artificial eye, I resolved to discharge the contents of the globe, believing an irritant, probably pus, to be within. A free incision was made through the cornea, and warm fomentations applied to the eye-no inflammation ensued.

8th July On examination, the globe had not shrunk by reason of the opening. There was found presenting at the incision and where the apparent pointing appeared, i. e. at the centre of the cornea, a foreign substance which was removed by a pointed instrument and forceps, and proved to be half of the rim or band of the percussion cap, which was unchanged, chemically, though it had remained in the globe for 18

months.

The thought presents itself, how was effected the contraction of the globe to one half its natural size, when there was no external wound. The result in this case may assist in drawing practical deductions as to the propriety of extracting foreign bodies when known to be, and favorably located within the globe, notwithstanding the authority of Lawrence and others of broken cataract needles disappearing without injurious consequences. From the specific gravity of the body-the metalic capand the place where it presented, I infer that it must have been imbedded in the lens and thus upheld, with a projecting end to irritate the iris, and on the contraction of the globe, the cornea also, and thus cause the ulcerative absorption of the latter, and pointing, preparatory for its discharge.

While upon the subject of lodgment and retention of foreign bodies, permit me to relate the following, which, though presenting nothing new to the surgeon, may be of interest to him who reads for curiosity.

In 1836, a sailor presented himself with a tumor, situate in the space which may be best designated as the " web," between the index and median finger; this pricked and pained on pressure. For history, he related that about two years before, he was engaged in rowing a boat for escape from officers of the customs in the West Indies, when a shot struck his oar, splintering it, and injuring his hand. This was dressed after his captivity, and healed kindly, but ever after he had felt this pricking when at labor, which had not been interrupted on account of it. He now applied for relief. It was removed and proved on examination to be a piece of wood inch long and irregularly jagged, and perfectly inclosed in a cyst or sack, although it had thus been constantly subjected to motion in this, the hand of a sailor.

Susan

To this I add this recent case. a girl at service, who, during the accustomed house cleaning in May last, while engaged in window cleaning, by a rapid and violent downward motion thrust three fine cambric needles, which were sticking carelessly in the sash, transversely into the wrist. Two of them were readily removed as they projected from the surface; the third was imbedded and out of sight. From its position and the resistance which the carpal bones were hoped to have presented to this needle passing eye first, and the external puncture being perceptible, together with the fact that on motion of the hand or fingers, or by pressure over the spot, a pricking sensation was felt, and thus locating it, I was induced to make incision through the skin, though it proved to no purpose, and I could not feel justified to search farther, as