pro bited from increasing the complaint by irregularity of conduct, and from fretting the parts by his anxious examinations,

IX.

Case of Diabetes treated by Blood-letting. Communicated by Mr SAMUEL M'KEUR, Surgeon, Castle-Douglas, to Dr CHARLES ANDERSON, Leith.

JOI OHN M'KINNEL, ætat. 36, labourer. November 15th.-Is affected with occasional pains in the stomach and bowels; is generally costive; his stools are voided with difficulty and pain; are of a white colour, and frequently tinged with blood; has always considerable thirst, and discharges a much greater quantity of urine than in health; has frequently observed that his urine in the forenoon is of a yellow colour and salt taste, and that in the afternoon it is more transparent and very sweet; has a sense of oppression in the chest, accompanied with palpitation of the heart; is sometimes troubled with nausea, and has always a very bad taste in his mouth; his tongue is covered with a brownish fur; the greater part of the teeth are failen out, those that remain are quite loose; his gums are very tender and spongy; his skin is dry and rough, but is not hide-bound; is very much emaciated; very weak, and although his wife is at present pregnant, considers his powers of virility a good deal impaired; is rather depressed in spirits, and says he finds greater difficulty of fixing his attention on any subject than when in health; pulse about 100, regular in frequency, but very irregular in strength; and on the whole very feeble. Weight 7 stone 2 lib.; his legs are considerably edematous; takes nearly, on the whole, the same quantity of food as in health.

These complaints commenced about two years ago with thirst, pain in the loins and epigastric region. For a year and a half he has observed very little variation in the symptoms, excepting the increase of debility; is reported when in health to have been fon of ardent spirits.

Has used a variety of medicines without any good effect, Animal food agrees well with him; but although he lived for some time almost exclusively on it, no sensible amelioration of his case could be observed.

Was about two months ago a good deal troubled with vertigo, which was relieved by bleeding.

November 16th.-Pulse 100, so feeble as to be with difficulty numbered; much oppression in the chest. viii. of blood were taken from his arm, being all that could be procured; veins so relaxed and empty that it is with difficulty any of them can be opened; pulse not altered by the bleeding, but feels a good deal relieved in the chest; laxative pills pro re nata.

17th.-Pulse scarcely to be felt; veins cannot be made tense by ligature; viii. of blood again procured with much difficulty; the energy of the heart seems almost gone; no alteration from the bleeding; the blood taken yesterday covered with a thin blue film; the substance of it very loose, and black in the bottom; serum exceedingly white. A large blister to be applied over both kidneys.

18th.-Blister rose well, but discharges little; other symptoms as before. Urine about xx lib. in the 24 hours; 3x. of blood again taken; no sensible effect from it; blood taken yesterday of the same appearance as before.

19th.-Pulse 104, more regular, and somewhat fuller; blister now runs well; 3xii. of blood taken; now for the first time it runs in a full stream; felt relief while flowing; pulse rather improved by bleeding.

20th. Blood taken yesterday firmer in texture than any formerly, and contracts more on the surface, with a thicker buffy covering; pulse as yesterday; 3xii. of blood again taken; veins now fill better, and the blood flows more forcibly.

21st.-Pulse about 100, considerably firmer; 3xvi. of blood taken; much relief while flowing; pulse not altered; lime-water ordered.

22d.--Pulse 120, but quite distinct; feels very languid; palpitation very distressing; considerable oppression about the præcordia; on the whole very unwell; drink and urine considerably diminished; blood taken yesterday can be suspended on a probe; feels most comfortable in bed, and cannot walk without difficulty; stools for the last two days rather brown, and without any blood; tongue a little cleaner; mouth still very bad tasted. Ordered powders of ipecacuanha and oxyd. antimon. c. phosphat. calcis.

;

23d-Sweated some through the night; feels to-day easier pulse as before; 3x. of blood again taken in a very full stream, and with great force; pulse sensibly weakened by it; otherwise it was intended to have taken a much larger quantity; much re lieved while flowing; never any tendency to syncope.

24th. Thirst lessened; in other respects as before; 3xv. of

blood taken; flowed with great force as in pneumonia; pulse before bleeding 108; after it 110, and much weakened. Blister to be repeated.

25th.-Blister discharges freely; serum of the blood taken yesterday of the appearance of the matter of a scrofulous abscess crassamentum has the tenacity of healthy blood; considerable buffy coat; has much less thirst, and voids about one-third less urine than before; thinks his mouth not quite so bad tasted as before; has sweated a good deal; skin softer and more natural; urine not quite so sweet.

26th.--In the morning while in bed, pulse 104; after being up 120, tolerably firm; rather more thirst to-day; urine not increased; 3x. blood taken, flowed more feebly; bowels regular; stools brown; sleeps tolerably.

On the 28th, 3xii. of blood taken; on the 29th a similar quantity. No material circumstance occurred, till December 1st, when a violent diarrhoea came on, with severe griping; drunk little since it came on; urine diminished to one half; pulse 100, and firm; little appetite; feels very languid; stools still brown. December 2d.-Diarrhoea continues; stools very dark brown ; very languid; griping very severe; pulse 100, tolerably firm; urine for these last two days not above ii fb.; thirst also greatly diminished.

3d.-Diarrhoea diminished; urine increased to the same quantity as before the diarrhoea, but drinks less; pulse as yesterday. Pills of calomel and ipecacuanha ordered.

4th.-3xii. of blood taken; pulse weakened by it; in other respects as before.

5th.-Blood taken yesterday tolerably firm; 3xii. more taken : pulse weakened again by it.

From this date nothing was heard of him till the 27th, when he returned nearly as when he left us. Urine continues about one-third less than when the bleeding was begun; thirst also less; tongue a good deal cleaner; has had occasional diarrhoea; bowels now, however, easy, and stools natural, which has not been the case for two years; pulse still weak, and varying very much in frequency; 3xii. of blood taken with no sensible effect, but that of making the pulse still weaker; blood much of the natural appearance. On the 29th, 3xv. of blood again taken; for the first time it produced some tendency to syncope, which continued for about two hours. The pulse, which before the bleeding was weak, vanished after it into a mere tremor. Thirst and urine

nearly the same.

Tinct. meloes vesicator. ordered.

Since that time he has continued by report nearly stationary.

About the middle of February, about 3x. of blood were taken from him, which produced immediate relief of headach and ge neral oppression, with which he had been for some days troubled.

Upon the whole, although some of the most essential diabetic symptoms are considerably abated, there is no appearance of eny thing like a return to health.

X.

Facts and Observations on Burns. By Mr ROBERT Lyall, Surgeon, Paisley.

So many papers have of late years been published on burns, that, by some practitioners, any further observations may be deemed superfluous. But let me ask those,-Whether medical men be yet agreed as to the best mode of treating burns? The answer must be in the negative; for different practitioners follow very different plans with such accidents; and every individual, no doubt, acts with the best intentions.

In the following paper, I have no wish to introduce any novel practice, but intend merely to give a statement of facts, and add a few remarks.

Dr Kentish, by his publications, brought about a complete revolution in the treatment of burns, and gained many followers. However, the practice he recommended, although well illustrated by cases, met with much opposition,-from some who were prejudiced, from some who never made a fair trial of his method of cure, and from others who, in my opinion, did not clearly comprehend his principles.

During my residence at Manchester, as house-surgeon to the Infirmary, &c. I enjoyed ample opportunity to try Dr Kentish's mode of treatment, and observe the effects. The results of my practice, for ten months, viz. from September 1808, till July 1809, were carefully marked in my note-book, from which the following statements are taken. * In the above limited space of

• The Surgeons of the Manchester Infirmary, to whom I am under many obligations, knowing the particular attention I gave to burned patients, left them in e great measure to my care.

time, the number of burns which were treated at the Infirmary, amounted to 25; and that of scalds, to 55-Total, 80.

Of the individuals who were

I dare say, that any one who carefully surveys the whole of the above table, will be inclined to draw a favourable conclusion as to the method of cure adopted. The first line of it may astonish some, the mortality among the in-patients being so great; and therefore I judge it necessary, in elucidation of this point, to state some circumstances of importance, relative to three of the fatal cases.

In the case of a woman, ætat. 40, the whole body, except the legs, was severely burned, in consequence of her falling into thre fire while much intoxicated.

She was brought to the Infirmary about two in the morning, (two hours after the accident), from some distance.

The weather being cold, and the woman very thinly clothed, shivering soon came on, and continued some time after her arrival. She was instantly put to bed. While bathing her with warm ol. terebinth. vomiting began; and, notwithstanding the exhibition of medicine, various kinds of diet, &c. continued to return, at short intervals, for three days, when she expired. Nutritive glysters were frequently administered.

In another of the fatal cases, the patient had for a long time been subject to epilectic fits, during the continuance of which she had often been burned from falling into the fire.

By the frequency of the fits, the repeated and long-continued suppurations in consequence of the accidents, together with habitual costiveness, and frequent ischuria, she was almost reduced to a skeleton; when, in another fit, she had the misfortune to be burned in the same manner.

Her neck, and tops of the shoulders, were scorched, so as to destroy the cuticle; but I considered the accident trifling, and made her an out-patient.

I made the distinction into burns and scalds, only because I wished to ascertain, whether the stimulating mode of treatment was equally applicable to burns produced in various manners.