4 OiN*n~rAL couau~IcATt01iB. be taken each night a pill, composed of half a grain of extract of nux vomica with two grains each of the extracts of aloes and of henbane; and that each morning an injection should be thrown up, care being taken, by means of a long tube, that the fluid should reach the seat of the assumed obstruction. This plan of treatment was pursued, under Mr. Stone's superintendence, until the 3rd of February, when I again saw the patient. I found no marked change. The tumour

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... mained the same, as did the state of sickness, and likewise the condition of the mouth and tongue. We arrived at no new conclusion, either as to the nature of the case, or as to the reason of the want of success in the treatment. We then directed that the pill should be omitted, and that a gentle current of galvanism should be transmitted through the bowel each morning for a few days; and that, with the view to alleviate the sickness, a small dose of prussic acid should be taken occasionally. The galvanism was applied on that day by Mr. Tylee, under Mr. Stone's supervision, and again on the three following mornings. There was, however, no satisfactory result; the sickness continued, and on the 8th the patient died. On dissection, we found a large nodulated mass, lying in -the situation already described, in contact with the abdominal parietes. It was soon found that this was the right kidney distended to an enormous size, the enlargement having been caused by fluid pressure from within, in consequence of obstruction at the commencement of the ureter. The cause of the obstruction was the presence of an uric acid calculus, firmly impacted in the mouth of the ureter. The structure of the kidney gave way in removing it from the abdomen, and its interior presented the appearance of a large multilocular cyst, containing a great number of small masses of uric acid coated with coagulated blood. On examining the left kidney, we found that it was in precisely the same condition as the right, only not so far advanced, and from precisely the same cause, namely, the impaction of a calculus at the origin of the ureter. The other organs, as far as the) were examined, were healthy. REMARKS. This case presents some interest in relation to renal pathology; but it is not under this aspect that I have brought it under notice, btut with reference to diagnosis. It will be remembered that I stated, as part of the history of the case, that a tumour, similar in every respect to the one which existed when I first saw the patient, had disappeared, all but a small mass, under the use of aperients; aiid that this circumstance was one main guide in the conclusion at which we arrived as to the nature of the case, and consequently as to the most appropriate line of treatment. Now, there can be no doubt Mr. Stone was quite right as to the fact, but that we drew an erroneous inference from that fact. I have no doubt that, coincidently with the treatment, the calculus at the origin of the ureter so far shifted its position as to permit the imprisoned fluid to escape, and that the kidney consequently collapsed; and that subsequently the calculus again performed the office of a plug, with the consequent redistension of the kidney. Now this is a combination of circumstances for which I ccrtainly was in no way prepared. The rapid disappearance of a large tumour from the right iliac region, under the use of aperients, with the reappearance of the tumour after a short interval, and this occurring in a woman sixty-five years of age, all pointed so strongly to the existence of foecal accumulation, together with the perfect agreement of the symptoms, subjective as well as objective, with this view of the case, that there certainly remained on my mind no doubt as to the correctness of the diarnosis. On the other hand, it is quite probable that, had we not had that misleading fact of the disappearance of the tumour governing our minds, we might have arrived at a more correct conclusion: for the left kidney had attained a magnitude quite sufficient to have admitted of its detection; and had its presence, in an enlarged condition, been recognised, it would of course have altered very much the elements of our diagnosis. Both kidneys had in this case undergone very extensive atrophy; the secretinIg substanlce of the right being re-duced to a mere shell. Still, thee was-no evdence dui life of retained urea in the: blood; and death took place without any comatose tendency being obseable. The urine was not examined; its appeance to the unaided sight was quite natural; and the frequent desire to micturate, which was the only abnormal circumstance, was attributed to irritation from the distended colon. Bath, tprii 1;4. f -[Rcad at the Quiarterly Meetings of the Bath and Bristol Branch, Mlarch '5th, 1451 .] IT has been abundantly shewn, that the morbid product in diabetes is the presence of a saccharine substance in the urine, of a low character, perfectly identical with the sugar of grapes and other analogous fruits. The source of this sug-ar or glucose has been traced to the mal-assimilation of the starchy or amylaceous element of diet, which substances, as soon as they have entered the stomach of a patient suffering from this disease, are at once converted into glucose. This is as rapidly taken into the current of the circulation by the venous system, and more slowly by the lacteals and thoracic duct, and is there eliminated by the kidneys, together with an abundant excretion of water. The name of glucosuria has therefore been most appropriately given to, the disease. In healthy digestion it appears probable that starch, although previously converted by the saliva into glucose, is further metamorphosed in the stomach into lactic and acetic acids. The former predominates; hence the amylum of the food is the probable source of most of the lactic acid of the gastric juice; which has been shown by Lehmann to owe its digestive powers in great measure to the presence of hydrochloric and lactic acids. In diabetes, therefore, it is evident that the conversion of starch stops in the metamorphic series at glucose, a sub. stance highly diuretic and abnormal to healthy blood, and which, appearing to be incapable of undergoing further metamorphosis in the circulating current, and being useless in the production of adipose tissue, and also incapable of subserving to the process of respiration, is eliminated from the system as an effete substance, constituting the most evident sign of the diseased condition of the patient. Although the quantity of sugar is materially lesseted in diabetic cases by the abstraction of all the starchy elements of diet, yet it does not wholly disappear; and some recent experiments point to another source of this morbific matter,. but at present we are not in a condition to say more than. this, that starch is "the prinwipal source of sugar in glucosuria, if not the only one." We are hence led to the following conclusions: either 1.. That the existence of sugar is an abnormal product in the digestive process; or, 2. That, if produced, it should be merely a transition state to some other proximate element of less stability, and nearer to the ultimate element of its assimilation; either lactic acid on the one hand, or adipose tissue or carbonic acid and water on the other. We have merely to recollect with what facility-certain chemical processes change glucose, and induce it to continue its metamorphic condition. Of all these processes, that by means of certain vegetable agencies appears to be the mogt. suited for the purpose we have in view-namely, the prevention of the arrest of the conversion of starch at the stage of sugar, when undergoing the process of digestion. It has lately been shewn, too, that certain vegetable organisms have the power, whilst endowed with vitality, of resisting the digestive powers of the stomach. The sarcina ventriculi may be mentioned as a case in point. It therefore easily follows, thatthe torula cerevisise,may be presumed to have an efficient action within the stomach, similar to its power of inducing fermentation in sacharine fluids.out of