Here, then, are individuals with sound lungs, in whom the development of tubercles may be foretold. Therefore, as we now know the nature of diabetes, we may, for this particular case, arrive at a positive ætiology of the tubercular affection.

In what does a diabetic patient chiefly differ from a man in health? More particularly in this, that in the healthy person, the feculent food dissolved in the digestive apparatus, and carried slowly into the circulation, is there completely consumed, no trace of it being afterwards found either in the faces or in the urine; whereas, in the diabetic, the feculents, rapidly converted into glucose in the stomach, are immediately absorbed; and this glucose, being in too large a proportion in the circulating apparatus to be normally destroyed, becomes eliminated by the kidneys. Hence there are three important circumstances which distinguish the diabetic from the healthy individual, viz.:-1, the perversion of the functions of the stomach, causing a rapid solution of the feculents; 2, the existence of a large quantity of glucose in the blood; 3, great activity of the secreting organs of the urine to get rid of the glucose. Important consequences proceed from these differences.

The active powers of the digestive organs, and the secreting apparatus of the urine, are uselessly employed for the support and repair of the animal economy. The nature of the transformations which the nutritive fluid is continually undergoing is modified by the presence of a considerable proportion of glucose in the blood. The food dissolved in the digestive apparatus being no longer usefully employed, the patient is supported at the expense of himself; hence the emaciation and wasting, with all its results. Now, the necessary effect of this anomalous condition is the spontaneous production, and the localization in the lungs, of tubercular globules, which eventually,, by their successive agglomeration, invade this organ and prevent its important functions.

The causes of the spontaneous evolution of tubercles for this particular condition are thus clearly established:

1. Perversion in the digestion of feculents.

2. Presence in the blood of a variable proportion of glucose. 3. Elimination of the glucose by the kidneys.

4. Replacing the glucose eliminated, by the slow destruction of the fundamental principles of the blood, the muscles, and the other organs.

May not analogous circumstances be met with in the different conditions under which tubercles become developed in the lungs or in other organs?

Apart from these cases, in which tubercles are developed as the result of the perversion in the digestion of feculents, can we not easily understand that other perversions in the important function of nutrition may cause the development of the tubercular affection? I hope, when our great work on digestion is completed, to be able to return to the nature of these perversions, which may be suspected after what we have published. I think, therefore, it would be of the greatest

importance to make some careful and accurate investigations into the manner in which the digestion and the assimilation of the different aliments takes place in persons in whom phthisis has just commenced or who are threatened with this disease. We should then establish an equation, as I have done with respect to diabetes; the food and drink would form its first term, and the principles contained in the fæces, the urine, and the other products of secretion or otherwise, the nature and quantity of which could be appreciated, the second. These investigations would lead to results equally precise with those I have obtained in diabetes. We may resume the contents of this paper in the following propositions:

1. The cause of the development of tubercles in the lungs of diabetes is a defect in nutrition and assimilation.

2. The tubercular affection has its origin, much more frequently than is imagined, in a defect in nutrition and assimilation, which cannot be known, and which can only be remedied by establishing an exact balance between the ingesta and the excreta.

3. It likewise originates in the excessive, continued, and unrestrained losses of fluids that are essential to the economy.

4. When a patient becomes emaciated it is important to ascertain as soon as possible the cause of the emaciation, and to remedy it ; we should thus alter the conditions which give rise to the spontaneous evolution of the tubercular globules.-Lond. Med. Times.

A case of Enlargement of the Thyroid Gland, treated by Seton. By HENRY KENNEDY, M. D.--In November, 1845, a woman, aged 35, applied to me on account of an enlarged thyroid gland. She had been married nine years, and had four children she has lived of late years in Dublin, and has always been healthy in every respect, excepting the disease she applied about. The gland had begun to enlarge so far back as the year 1832, thirteen years before my seeing her. At first it had increased very slowly; but the last year or so, she said, it grew more rapidly. When I saw it the tumour was at least the size of the largest orange; it was very hard to the touch, as if it were solid, but was divided into two portions, of which that on the right side was much the largest; it did not vary in size at the menstrual periods. It was not, however, on account of the bulk of the tumour, for in that respect there was nothing remarkable, that the patient applied for relief, but because it had affected her swallowing from a very early stage of its growth; and this symptom had latterly become much more distressing: solids were more difficult to get down than fluids, as might be expected. She referred the obstruction to the seat of the tumour. She told me she had shown it to other medical men, but she considered it still increasing. I ascertained that iodine had lately been used, both internally and externally for some weeks.

Under all the circumstances of the case, the tumour and dysphagia on the increase, and iodine having got a full trial, I determined on some more decided line of treatment, the more readily as the patient

herself was most anxious that something should be done. The plan by seton seemed to hold out the best prospect of success, and it was carried into effect, having previously brought the health to the best condition. The first seton was passed on the 30th of November, 1845. A common curved needle of the largest size, with its eye nearly full of double silk thread, was passed from below directly upwards, through the anterior portion of the tumour, about half an inch from the middle line of the neck, and including a space of at least one inch and a quarter between the entrance and exit of the seton. This was then fixed so as to prevent its slipping out, and the patient was desired to keep a poultice constantly applied, and also to keep her bed for two days; no unpleasant effects followed. It is enough to state here that this first seton was withdrawn at the end of ten days; that at the end of a fortnight a second one was passed; that it was double the size of the first, and its introduction was followed by a very considerable degree of constitutional irritation, which, however, subsided in about four days; suppuration then became very fully established, and the seton was withdraw, after being in twelve days. With the exception of poulticing, nothing was done during the next four months. In this time considerable changes had taken place in all the anterior portion of the tumour, and that part of it which occupied the left side; it had become very hard, and gradually, but steadily diminished in size. The larger portion of the tumour, however, occupying the right side of the neck, remained stationary. It appeared, indeed, as if it had grown somewhat larger; but this was not certain. A third and last seton was passed through this portion of the tumour in the month of April, 1846; its direction was upwards and outwards, so as to take in the longer axis of the swelling. This seton was four times larger than the previous one; it was passed with a large packing-needle, with the edges and point properly ground. After sixteen days the seton was withdrawn, the suppuration being then very considerable. Finally, after four months more, the entire tumour had so much lessened, that it might be considered as cured. The entire process occupied between eight and nine months.

At the present time (January, 1847) the eye cannot detect any tumour, but to the touch one remains, which is probably the size of a small chestnut. There is no deformity whatever, and very trifling marks of where the setons had been passed. The patient, too, feels no difficulty of swallowing, at least none that causes any inconvenience.

As I wish here to confine myself merely to the facts of this case, I have purposely omitted the consideration of several points which might fairly admit of discussion; such as the nature of the tumour ; the question of a more general use of this plan, after the more ordinary means have failed, particularly iodine; the nature of the dysphagia, as to whether it was nervous or mechanical; the causes of those enlargements, and other points connected with the subject in a general way. It is to Quadri, of Naples, that we are indebted for the plan of treatment put in force in the present case. Not being certain

of what the result of the treatment would here be, I did not take the precaution of getting a cast of the tumour when it was of large size. This, probably, is of less consequence, as the patient has been seen by several gentlemen to whom I may here refer. Dr. Clarke, of Herbert street, saw her repeatedly; he took much interest in the case, and kindly gave me his assistance. At a late stage, and after all the setons were withdrawn, the patient was seen by several physicians and surgeons of this city.—Dub. Quar. Journ.

Case of Softening of the Heart in a Person who was believed to have died of Starvation and Exhaustion. By B. G. DARLEY, M. D. Coolock. On the 4th of January, 1847, I was requested by the coroner to examine the body of an elderly female, who was reported to have died of want and starvation in this neighborhood. The history of the case was shortly this: she was a poor woman, who obtained her living by wandering about from place to place, and was in the habit occasionally of stopping a day or two in the house in which she died. She had come there three days before the above date, and complained of much weakness, and was suffering, as the people in the cabin said, from "a kind of asthma." She had some tea to drink, but eat nothing. She died on the 3rd instant, apparently from exhaustion. On opening the chest, the lungs appeared healthy, and collapsed slightly; there was no water in the pericardium, the heart was larger than natural, the auricles greatly distended and full of blood. On lifting up the apex to see the size of the heart, my fingers went through the substance of the left auricle, and this with a very slight pressure indeed; out of the rent made by my finger poured a great quantity of fluid blood which filled the pericardium; the right auricle was in the same condition, literally choked with fluid blood, and in this auricle it was of a very dark colour; but the most remarkable character was the softened state of the walls of both auricles, particularly the left; they were of the same colour and as friable as the liver, and not unlike portions of lung affected with pulmonary apoplexy. The increase size of the heart appeared chiefly made up by the great dilatation and distention of the auricles; the ventricals did not appear larger than natural; they were empty of blood, and their muscular structure was of a pale colour.

The omen

The viscera of the abdomen were generally healthy; the stomach was contracted, and nothing in it but a half pint of a dark colored fluid; the intestines in parts were occupied by the same. tum was destitute of fat; indeed the absence of adipose tissue throughout the whole body was remarkable.

The brain was examined, and was perfectly healthy, but particularly bloodless.

Now what was the cause of death in this case? There was no lesion of the brains, lungs, or viscera of the abdomen, and though the heart was as described, it had preserved its integrity, at least there was no solution of continuity within its walls; and this might readily have taken place, considering the softened state of the auricu

lar tissue, had the individual lived a little longer, and the auricles had power to act on their contents; in such case death, most probably, should have been laid to the door of a diseased heart, and not as, in my opinion, the result of an altered state of the contained blood.

The coroner's jury returned a verdict, that "death was caused by want and destitution."

In a physiological point of view, I should say that insufficiency of nutritious food rendered the heart unable to expel its contents, its muscular structure, particularly that of its auricular portions, was so softened and weakened as to allow of dilatation to the greatest possible amount; the blood gradually accumulating, congestion took place, and the woman died of what we may call congestive apoplexy of the auricles of the heart. The manner this is caused by starvation is thus the blood is rendered thin, has little or no fibrin in it; the heart, along with the general muscular system, is weakened, and unable to expel its contents; congestion takes place; its cavities, particularly the auricles, yield to pressure; and, as is the case in all muscular cavities when distended beyond a certain extent, atony supervenes, the muscular fibres no longer contract, and death is the result.

:

From this examination, the difficulty of breathing during life may be explained, and, had an opportunity been afforded before death, we should probably have found the pulse slow and intermitting.

This case differs from the fatty degenerations of the heart in many particulars. First, this, as we have seen, engages the auricular portions of the heart, while it is the ventricles that are generally occupied by fatty deposition; again, it is in the corpulent and the full habit that the heart is predisposed to the fatty degeneration, whilst the softened auricle will be found in the ill-fed and destitute; again, the mode of death in the former has more of an apoplectic character, whilst in the latter the spark of life ebbs out from want of sustenance and vital power. In the fatty heart, the solids are the first to suffer, whilst in the other the mischief begins in impoverishment of the fluids.

As I fear the profession in this country will have many opportunities of examining the bodies of individuals dying under similar circumstances, though the case above noticed might have occurred at any period, I think it might be interesting for medical men to give reports of their examinations, and to observe the state of the several viscera, and especially the heart, in such cases.—Ibid.

A Case of profuse Hæmaturia, the result of Injury, treated successfully with Gallic Acid. By JAMES S. HUGHES, F. R. C. S., Surgeon to Jervis-Street Hospital.-John Hyland, aged 30, a Custom House porter, admitted into hospital on September 8th, 1846; states that, about half an hour before admission, he was employed in lowering a cask full of sugar, when he was struck by the handle of the windlass with great violence in the left lumbar region; he was rendered insensible for a short time, and was carried into the hospital. On examination an extensive ecchymosis was found to exist along the left