sed by Dr Baillie. "From the state of the kidneys," says this celebrated morbid anatomist, "upon examination, it seemed to me probable, that diabetes depends, in a considerable degree, upon a deranged action of the secretory structure of the kidneys, by which the blood there is disposed to new combinations. The effect of these combinations is the production of a saccharine matter. I think it probable, at the same time, that the chyle may be so imperfectly formed, as to make the blood be more readily changed into a saccharine substance by the action of the kidneys *"

The cause of the imperfect animalization of the blood will necessarily appear to be imperfect digestion, or defective assimilation of the aliment. This by some has been supposed to depend on disease, either in the structure or functions of the liver. This was the opinion of Actuarius among the ancient, and of Mead amongst the modern medical writers; but later observations have not confirmed this idea. Dr Home examined very carefully one of the cases before mentioned, which terminated fatally, and reports the liver "natural." Dr Baillie's history of the dissection of a case, which occurred to him, at St George's Hospital, London, is very satisfactory: He remarks, "the liver, at the same time, I examined with care, because it has been thought by some to be the chief source of disease in diabetic patients; but it was perfectly sound. Even allowing the liver to be sometimes engaged, it is a circumstance which, as Cullen observes, does not often take place, and therefore the disease must acknowledge a different cause. The mesentric and pancreatic glands have likewise been said, in some instances, to have been enlarged and diseased; and the latter, especially, have been found, in two cases, to have been much altered in their structure, by an eminent profesional friend of mine, in Cork, whose name I am not at liberty to mention; but this is only casual, and cannot be set down as the general cause of diabetes; yet one idea strikes me, from a consideration of the histories of the chylopoetic viscera being sometimes found diseased in this complaint, and which I submit with much diffidence: It is, that where diabetes resists the plan of animal diet, it may be fair to conclude, that diseased structure may be the cause, and thence, that a mercurial course might be, at the same time, attended with advantage. The utility of this plan will perhaps be more apparent from a consideration of the declaration of the very accurate and learned Dr Willan, in his reports on the diseases in London," that this disease

* Baillie's Morbid Anatomy, p. 276. 2d edition.

disease has been relieved, and the saccharine quality of the urine removed by animal diet, and the general plan recommended in Dr Rollo's treatise on this subject; but I never yet," he continues, "met with a confirmed case, wherein there was not some considerable disorder of the constitution, or a defect in some organ essential to life *."

I do not see that any advantage is to be expected from local applications to the region of the kidneys: That the affection of those organs is but secondary, or, in other words, is dependant on the defective assimilation of the aliment, and the consequent imperfect animalization of the blood, will hardly be denied.; and the admission of this fact is necessarily followed by that of another, that the cure does not lie in any medicine or application, acting directly on the urinary organs, but in altering and correcting depraved digestion. This is most effectually done by the administration of those remedies which impart tone to the organs concerned, and by affording that kind of aliment only, whose direct tendency is to promote the animal process.

I shall conclude this communication, by adverting to the place which this disease should have in systems of nosology. Dr Cullen has placed it under the order of spasmi. This improper arrangement has been wisely accounted for by Dr Willan, when he says, "most of the plans of nosology are exceptionable, as being founded on hypothetical principles, rather than a strict analogy between the diseases put in the same order+." If we attentively consider the circumstances attendant on diabetes, the emaciation, debility, œdematous swellings of the legs and feet, and, in some cases, (particularly towards the close of the disease), the quick pulse, and hectic flush, we shall be inclined to take the disease from the order in which Cullen has placed it, and rank it under the class of cahexia, and amongst the marcores. The tabes sudatoria resembles much, in its nature, diabetes; the former is attended with a diseased state of the primæ viæ, and cutaneous vessels, the latter with a diseased state of the primæ viæ and kidneys : In the former, the skin is evidently relaxed, and the histories of the dissection of diabetic patients shew a similar laxity and softness of the kidneys. The perspiratory discharge in the former, when collected on a sponge, speedily acquires a sour odour; the urine in diabetes soon undergoes the same change. To these may be added, that in the tabes sudatoria the urine is very scanty, while in diabetes the perspiratory discharge is, in a great measure, suppressed;

*P. 186.

See Preface to Reports on Diseases in London, p. 111,

suppressed. The other symptoms are nearly the same; emaciation, debility, and hectic, equally mark both diseases. The analogy then, which subsists between diabetes and diseases usually ranked under the head of cachexia, would, as before mentioned, strongly incline me to place it in that order. Cove, Cork.

V.

Case of extensive Injury done to the Canal of the Urethra. By KINDER WOOD, Member of the Royal College of Surgeons, London.

THOMAS MILLS, a collier, æt. 60, February 25th, whilst in the

pit, fell backwards, and the perineum came in contact with the corner of a tub. I saw him in a short time after the accident; the scrotum was swelled, of a deep blue colour, as if filled with extravasated blood, and very painful; the pulse was very quick, feeble, and easily compressible; the whole surface of the body was cold, and the rigors very severe. In such a state,. afraid to take away blood generally, six leeches were applied to the scrotum, as the pain was very violent; a spirituous lotion was applied, and he was desired to take freely of warm gruel, and to be kept warm. In the afternoon, the scrotum had enlarged so much, as to thrust the testicles violently against the abdominal ring, producing excruciating pain; a little blood had passed by the urethra, but not a drop of urine. There was a great sense of distension of the bladder, for which, with great care the catheter was introduced, and about 3ij. of bloody urine brought away with great relief; the rigors were less violent. As the urethra appeared clearly to be ruptured, and the scrotum distended with blood and urine, a large and deep incision was made in the scrotum and perineum, from which issued slowly a bloody urinous fluid. An anodyne fomentation was applied to the parts with great relief, and 1 gr. of opium administered. The sensation of distension of the bladder became again very severe during night, and, at the earnest request of the patient, the catheter was with great care introduced, but only a trifling quantity of bloody urine was brought away; during the night he became delirious.

26th. The region of the bladder is very sore, and there are violent and painful contractions of the bladder, whenever the

least

least quantity of water is collected; the tumour of the scrotum is less, and the urine oozes freely through the opening. Fever slight, bowels costive. Three more leeches were applied to the hypogastric region, a draught with ol. ricini exhibited, and a clyster of milk; he was ordered every three hours to take a saline mixture, with antimony.

27th.-A. M. very feverish; scrotum rather larger, harder, and sore. Continue the mixture and fomentation. P. M. rather better, skin moist; soreness of the abdomen, and irritable action of the bladder diminished; pulse more free, and has had two stools.

28th.-Pulse soft and regular, thirst slight, bowels open, fever abated, scrotum rather less.

March 1st.-Fever rather increased, pulse hard, constant heavy pain in the scrotum; irritable state of the bladder quite gone. Continue the mixture and fomentation, and at bedtime take an anodyne draught.

2d.-Pulse sharp and frequent, tongue covered with a brown fur; has passed two or three loose stools; the lower part of the scrotum is in a gangrenous state; the testicles enlarged and sore. Was ordered wine freely, and given the decoction of bark with the tincture, and an opiate at bedtime.

3d.-Laid open a small abscess in the perineum, and made an incision into the mortified slough, which is surrounded with an inflamed line; the pain is very violent when the urine passes through the opening. He was ordered the bark in substance.

4th.-Has had a violent diarrhoea; pulse quick and soft, tongue brown, and slight confusion in the head. The decoction was again resorted to, and xv. gr. of kino given every two hours. In the evening, the diarrhoea was less violent.

5th. Every thing going on well, and the slough separating ; on the 9th it had come away, leaving a clean wound; the extent of the sloughing could now be seen; the bulb and membranous part of the urethra, with a considerable portion of the left tunica vaginalis had come entirely away, exposing the anterior portion of the prostate gland, the crura of the penis, and a considerable part of the left testicle, covered with its tunica albuginea. A bougie could be easily passed into the bladder, through the remains of the urethra, which projected about th of an inch from the prostate, florid and protuberant, as if formed by new granula

tions.

13th. The pain is so violent when the urine is passed, that a female catheter was introduced; the appetite is better, and he up a little in bed.

sits

15th.-An elastic catheter was introduced, but was obliged to

be

be withdrawn. Since the female catheter was used, the granulations, which seemed to have been repressed by the urine passing over them, have risen up vigorously.

224.-The elastic catheter was again introduced, and remained six hours, when it became uneasy; sits up, and stands very well.

23d. The elastic catheter was again introduced, and suffered to remain; and from this time the granulations pushed rapidly

around it.

April 1st. The granulations appearing flabby, and the matter becoming thin, the wound was daily sprinkled with the pulv. rhei, when they quickly became of an healthy appearance.

9th. The catheter has been retained till this day, by a slip of adhesive plaster passed round the penis, including a thread fastened to the head of the catheter; in the night the patient pulled it away, and in attempting to pass it again pushed it through the fresh granulations in the perineum; I again introduced it, but with great difficulty.

13th. The urine comes in a small stream through the catheter, and, occasionally, a good deal through the wound; on the 18th, the catheter was, from necessity, withdrawn.

29th. A fresh elastic catheter was introduced, and remained for five weeks, when it became clogged up with mucus, and its internal surface so injured by the passage of the urine, that the silver wire could not be passed down when it was withdrawn ; at this time the opening would not admit the head of a common silver probe with ease. A bougie was passed down beyond the opening, and the part freely scarified and stimulated with the red precipitate. When the patient applied his finger to the opening in the perineum, the largest portion of the urine passed by the natural passage, and only the last portions through the opening. It gradually contracted till July 4th, when it was completely healed, and the consequences became very troublesome. The urine was not expelled through the urethra; he had a sensation as if the urine passed down to the perineum, where the opening had been; then came on violent pain in the belly, rigors, and difficulty of breathing; and these continued for nearly three hours, when the urine again passed by drops through the perineum : it then came in a small stream, and the opening being now much enlarged, the bladder was evacuated, and the symptoms went off; a full sized bougie could be passed beyond the opening in the rineum, but not into the bladder. Affections of this nature had come on as the opening became less, but they did not become severe till it was entirely closed; since that time, the opening has once again become very small, and the urine passed through it

pe