bile secreted becomes abnormal in quality, and this circumstance produces disturbances of digestion. Again, this bilious state being transferred to the entire mass of blood, general febrile irritation arises, a disposition to jaundice, intermittent fevers, bilious fevers, which at length pass into nervous fever; whilst the arterial character of the blood is diminished in this state, the absorption of oxygen in the lungs is impaired, and accordingly the natural excitement of the nervous system is interrupted, its own healthy self-excitement being also destroyed.

That the liver itself should suffer most in consequence of these abnormal states of the blood-moulting, depends on this circumstance, that it is itself the normal blood-moulting organ, and that the morbid directions of this function press most upon it. The human liver is in Summer, and in Tropical Climates, reduced to the state of the sheep's liver, and, in fact, the study of liver disease in the sheep is well adapted to throw light on the diseases of the human liver. All these states are perfectly inexplicable, according to dynamical and chemical Physiology. [Beiträge zur Physiologischen und Pathologischen Chemie und Mikroscopiæ. Berlin, 1844.]

MORBID FORMATION OF SUGAR AS A RESIDUUM OF ABNORMAL CHYLIFICATION, (NOT ABNORMAL CHYMIFICATION.) By Professor Schultz of Berlin.

(Beiträge zur Physiologischen, und Pathologischen Chemie und Mikroscopie, &c. Berlin, 1844.)

The morbid formation of Sugar is most striking in diabetes; but sweet pus is often secreted in consumption also; and it is worthy of remark, that most diabetic patients die of consumption. No calculations have been hitherto made with respect to the quantity of Sugar voided in diabetes; but the quantity of sugar is of importance in reference to the qualities of the food, which become changed thereto. In diabetes, so much sugar forms in the urine, that of 62.03 solid parts in the same, 58.15 are sugar, and often still larger proportions. The fluid urine contains often from five to eight per cent. of sugar; so that in a discharge of five quarts of urine from eight to twelve ounces of sugar are voided. The sugar is grape-sugar, not always sweet, but still it has the property of fermenting. The blood of diabetic patients contains sugar only in small quantity, no doubt, as it is voided again. Rollo proved this to be the case; afterwards it was not believed; but Gregor, Bouchardat, and Simon have confirmed the matter. Gregor shewed that the sugar arises in the stomach, as it has been found in the vomitings of a diabetic patient, and even in the excrements. The latter is striking and interesting, as the formation of sugar in the stomach, especially from vegetable diet, is a general physiological phenomenon, which hitherto has been too much overlooked.

We have shown elsewhere, that all mealy aliments, and therefore bread, become changed into sugar by saliva. It may be an error, then, when Gregor states that he found no sugar in the gastric contents of a healthy man, premising that he had eaten bread or pulse with meat. But, according to Rollo, and according to our own observation also, diabetic patients form no sugar from meat, no more than the healthy stomach does. It has been shown that animal food is changed in the stomach only into lactic acid, not into sugar. The difference in diabetic and healthy cases consists only in this, that, in the healthy state, the sugar of the chyme formed from vegetable diet, becomes deoxidized again after the admixture of the bile in the duodenum, and, at the same time, is changed into an albumen-like substance; but this does not occur in diabetic states, so

that here the sugar proceeds unchanged from the stomach into the intestine. The cause of the morbid Saccharification in diabetes lies, accordingly, not in the Chymification-process of the Stomach, but in the Chylification-process of the duodenum, and accordingly much more in the liver, which does not pour good bile into the duodenum for the purpose of a healthy chylification. Defective secretion of bile contains the grand cause of diabetes; hence, when there is a deficiency of bile, or when the bile is bad in quality, the intestinal contents contain sugar until its evacuation through the rectum. Besides all this, the chyme in the duodenum continues sweet and acid, during chylification it does not pass into the normal formation of albumen and fat, and in this lies the cause of diabetes.

We have made the observation, in the case of a diabetic female, that the medicinal use of fresh bile, from four to six ounces daily, perceptibly checks the formation of sugar in the urine. We have subsequently made several similar observations, more particularly in the case of a woman who was suffering under confirmed diabetes, and where, after the use of a sufficient quantity of fresh bile two hours after meals, the sugar entirely disappeared in the urine. The doses of bile hitherto given in diabetes have been too small; and hence, doubts have been entertained respecting its action.

The origin of the sugar accordingly proceeds from the intestinal canal, but not from the stomach, as M. Gregor maintains. We have twice found sugar in the lymph and portal blood of scrofulous children. But, true diabetes seems to occur only, when through the deficient formation of blood in general, a morbid process of waste has set in. For the sugar absorbed in the healthy state by the vena portæ is never eliminated through the urine, but, like all the nutritive parts of drinks, is deposited in the spleen and in the glands of the mesentery, and there subjected to a new elaboration and sanguification. Accordingly, the sugar introduced into the blood by nutrition, in the case of healthy dogs and horses, is not again found in the urine. The cause, why the sugar is eliminated through the kidneys in diabetes, a thing which does not occur in the healthy state, still requires investigation.

ON THE ORIGIN OF MELANOSIS. By Professor Schultz, of the Univer sity of Berlin. (Beiträge zur Physiologischen und Pathologischen Chemie und Mikroscopie, &c.)

IT has been the custom hitherto to represent melanotic masses as products of diseases of the liver and spleen; nor could it be otherwise, taking into consideration the hitherto state of our knowledge regarding the blood, and the share it takes in abdominal diseases. Heusinger has treated the subject at full length in his work on the spleen. But the truth is, both the liver and the spleen are wholly unconcerned in the formation of melanosis. According to what we have stated elsewhere, regarding the formation and development of the blood, and its two renewal-acts of formation and moulting,* melanoses arise solely from a morbid moulting of the blood. As the vena portæ is the natural rendezvous for the blood-moulting-material, the bile, disturbances of the blood-moulting will be usually connected with affections of the liver and spleen: but the spleen is just as much concerned in this as the glands of the mesentery, from which also the roots of the vena portæ take their rise; and the spleen is just as little primarily diseased as the liver, but merely in consequence of the moulting-ob

See the author's work, entitled System der Circulation, and Verjüngung des Menschlichen Lebens.-Rev.

structions of the blood. This is a point of high practical importance, as we thence see that melanosis is more an abnormal blood-moulting, thrown upon another organ, and depends on an overfilling of the vena portæ, and ultimately of the entire mass of blood with melanotic blood-vesicles, which may occur without any affection whatever of the liver and spleen. We have shown, on another occasion, that the cruor of the portal blood is quite distinguished from the cruor of the arterial and venous blood, and that, by its very dark colour, it closely resembles melanotic materials. That the separation of the melanotic masses is so frequently thrown on the lungs, was once considered as a proof that the lungs may take on the function of the liver, whilst the sole and only true cause is, that, amid the general melanotic state of the blood, this fluid becomes obstructed in the peripheric system of the lungs, and accumulates here, because it lacks the moving force, so that in the disposition to passive congestions of the lung, occasioned thereby, a tendency arises to throw off the melanotic materials directly in this organ.

With respect to the influence of the lung and liver in the so-called decarbonisation of the blood, an entirely incorrect view has been taken hitherto. It has been believed (and Tiedemann has taken great pains to prove it) that lung and liver may act vicariously in decarbonizing the blood, so that, when the function of the liver is interrupted, the lung takes on it that of the liver, and vice versa. Tiedemann accordingly supposed, that throughout the entire animal kingdom there exists a contrast in the development of the lung and liver, that animals with large lungs have small livers, and animals with large livers have small lungs; as an instance of this, Tiedemann adduced Water-birds and Mollusca. But this is only apparent. The liver can only separate the black colouringmatter of the effete blood-vesicles, without ever having a necessity for oxygen, because the oxygen no longer acts on the defunct vesicles; its action refers only to the moulting-formation of the blood. The lung can only separate the carbonic acid from the young and still living vesicles, wherein the absorption of oxygen gas is necessary, in order to irritate the blood-vesicles to contraction; lung and liver never interfere with each other's function. In Mollusca the entire blood is found in a bilious state, because all the colouring matter is deposited in the plasma. These animals have therefore a natural black jaundice, and they are almost all black, and separate so much bile merely from this cause. A similar state of things is observed in water-birds without these animals having. smaller lungs than other birds. It is, therefore, incorrect to maintain that the deposition of melanotic substances in the lungs depends on the natural tendency of the lungs to separate carbon instead of the liver. For the question here, is not concerning the separation of carbon in general, but concerning the separation of the black colouring matter of the blood. If the lungs deposit blackcolouring matter in them, this is to be considered rather as a morbid state of the lung itself; a state in which the lung suffers only as a consequence of the action of the melanotic and of the bilious blood formed therefrom, and is thereby obliged to separate the black-colouring matter. Accordingly, it is not the lungs alone in which such melanotic substances are deposited; these depositions may take place in all organs, in the cellular tissue, in serous membranes, glands, in the brain, where obstructions of melanotic blood form, as is proved by experience. In Tropical climates European women sometimes have black menses. Nay, it is probable. that the intestinal canal is much more frequently the seat of melanotic depositions than the lungs. After dysentery and yellow fever the entire intestinal canal is found to present as black an appearance as the biliary passages. It is certainly a circumstance worth noticing, that certain external influences which act on the lung, as air impregnated with marshy vapours, may produce a bilious state of the blood, wherein the lung then re-acts on the liver. But surely we must not infer from this a vicariousness in the action of the lung and liver; the real fact being that, in consequence of the carburetted-hydrogen gas, a paralysis of the

blood-vesicles is produced, whereby much more colouring matter is dissolved in the plasma, and the bilious state is occasioned by the melanosis, which disposes to the secretion of the colouring matter abnormally, just as in the healthy state in the case of Mollusca. In all this the liver never takes on itself the function of the lung; nay, rather the liver still continues the portal of death, the lung the portal of life, with respect to the vitality of the blood. The lung must separate bile, and the liver must exhale carbonic acid, if these organs are mutually to interchange their respective functions. It is then much more to the abnormal state of the blood than to the action of the lung and liver that we must refer the formation of melanosis. The blood must throw off from itself the moultingsubstance of the effete vesicles; the vascular intestine by which this is accomplished is the vena porta. The melanotic blood is not attracted by the lungs; it is rather repelled by them; and it is attracted by the liver only in the healthy state, in order to eliminate the moulting-material as bile. If any obstruction occur here, the morbid deposition may be directed to various organs. If the liver become affected under these circumstances, it becomes so only in consequence of the abnormal blood-moulting, and not primarily; hence the liver is never to be blamed for the formation of melanosis, it is itself affected only when Melanosis has been formed.

THE TRANSACTIONS OF THE PROVINCIAL MEDICAL AND SURGICAL ASSOCIATION. Volume XII. 1844.

THE present volume consists of TWO PARTS; the first part contains two retrospective addresses, one by Dr. T. Shapter, of Exeter, in which the improvements made in the various branches of medicine within the last year are presented to the notice of the Association; the other, by William Hey, Jun. Esq., Surgeon to the Leeds Infirmary, on the recent Improvements in Surgery. The Second Part consists of Essays and Cases. The first Essay is on the Actual Process of Nutrition in the Living Structure, demonstrated by the Microscope; and the Renewal of the Tissues and the Secretions from the Blood thereby illustrated. This is from the pen of William Addison, Esq., F.L.S., &c. already favorably known to the profession for his microscopical researches in Minute Anatomy. This Essay is accompanied with plates. We shall present to our readers a succinct analysis of the more important parts of this Essay. The author of the Essay first remarks that microscopical observers are not yet agreed with respect to the place of origin and the structure of the red corpuscles, together with the relation existing between them and the colourless ones. Both the red and the colourless corpuscles or cells circulate in all the capillary blood-channels of the human body. The object of the Essay is to trace the several stages through which the latter pass in their progress through the tissues, to describe the visible or physical characteristics of their contents, and to investigate the probable result of their final dissolution.

"The coagulation of the buffy coat of the blood," says the author, "is a glaring instance of an elastic, compact, fibrous, and colourless tissue, resulting from the fibrillation and incorporation of the colourless elements of the blood: the experiment related in the following paper is a glaring instance of the actual formation of this tissue, in which we see how the colourless blood-corpuscles and the molecules are included in, and incorporated with, the fibres; and, lastly, the accumulation of the colourless blood-corpuscles in the capillary vessels in the web of the frog's foot after immersion in warm water, their adhesion to the walls of the vessels, and their situation, first between the red current and the tissue, and then among the fibres of the latter, is a glaring instance of the process of nutrition."

SECT. 1.-Some years back the author published several cases demonstrating the existence of great numbers of colourless corpuscles in the buffy coat of the blood-he subsequently published the fact of the lymph globules being seen accumulating in the irritated vessels of the frog's foot; he then stated that a thin film of the coagulated fibrine from the surface of inflammatory blood had all the structural characteristics and physical properties of fibrous or membranous tissue. The process by which this tissue is formed he has called fibrillation; it takes place in the liquor sanguinis. These colourless corpuscles were found to exist in the blood at all times; and were more abundant in blood drawn from vessels whose calibre was increased by inflammation, or which were administered to an accelerated process of nutrition. The author, by following up his experiments, came to the conclusion that lymph and pus-globules, exudation-cells, and epithelium, originate from the colourless corpuscles. This conclusion was strengthened by the fact, that the fibrine of the liquor sanguinis was never seen during the progress of fibrillation to give origin to a corpuscle or globular particle of any kind. The author here details some experiments, proving that the buffy coat of the blood is neither more nor less than elastic fibrous tissue. By means of them he also endeavours to account for the formation of the buffy coat of the blood in all those cases in which its presence is connected with disordered function or disease. From sundry causes, the process of nutrition, or what amounts to the same thing, the function of secretion, is disturbed or diminished, and the colourless corpuscles, therefore, accumulate in the blood. When a vein is opened, a greater number than usual flow out; from the sudden change of temperature to which they are exposed, or from other causes, many of them burst or become ruptured, and discharge their contents, consisting of a liquor sanguinis and molecules. After standing a short time, the liquor sanguinis rises to the surface, drawing up not only the molecules which were associated with it in the interior of the corpuscles, but also all those colourless corpuscles which have preserved their integrity amid the changes to which they have been exposed; here it very shortly fibrillates and forms tissue, as it would have done in the living vessels, had the contents of the corpuscles been appropriated to the purposes of nutrition. Hence, neither the fibrinous element nor the serum circulate in the blood as part of the fluid in which the red corpuscles are suspended in the living vessels; they are both inclosed within, and form, incorporated together, an essential ingredient of the interior contents of the colourless corpuscle. He ascertained by experiment, that on placing a drop of white and opaque healthy pus on a slip of glass, and well mingling it with a drop of liquor potassæ, it entirely lost its opaque character, and became clear and transparent, resembling mucus-the effect of the alkali is to destroy the pus-globules. This experiment sets at rest the difference between pus and mucus, and confirms the identity of mucus and pus-globules. From a number of experiments here detailed the author draws the following conclusions :

1st. That the plastic fibrillating liquid, denominated liquor sanguinis, exists as a fluid within the colourless blood-corpuscles, and that, when it escapes from them, it forms an elastic fibrous tissue, the serum being the residual liquid.

2nd. That mucous and pus globules are altered colourless blood-corpuscles, and that the glairy fluid termed mucus is nothing more than an altered state of the fibrillating liquor sanguinis, the change from the one to the other being coeval with the changes which characterize the microscopical aspect of the corpuscles. Hence, if we take the red portion of the buffy clot, and the red bloodcorpuscle, to represent blood, then the colourless layer of liquor sanguinis with the colourless blood-corpuscle will represent the first remove from blood, and mucus or pus, with the mucous or pus globule, will be the next. And it would appear, generally, that the nearer the corpuscle is to, or the fewer the stages of its removal from, the circulating fluid, the more nearly it resembles the colourless blood-corpuscle, and the more decidedly and visibly its fluid contents, when