have sometimes been founded upon one of these suppositions, and sometimes upon both. "Causa igitur determinata consistere debet in his duobus momentis: 1mo, In bonorum humorum ex chylo generandorum degeneratione in materiam excrementitiam ad urinæ vias abire solitam. 2do, In concurrente dispositione renum. Quod autem illud est quod in illa actione subigentium et præparantium serie obveniens, impedit elaborationem utilium humorum, illud non constat, ejus enim non habemus experimenta sufficienta. " *

Since Metz's time the labours of chemical inquirers have greatly augmented the wonders of diabetes, and brought within the range of philosophical discussion many phenomena which were before left to the credulous fancy of old medical writers. Yet still the opinions afloat amount to a mere expression of the fact; they do not illustrate the causes, or even the first series of changes, in any degree. If the assimilation of food were imperfect, the blood must differ in its chemical composition from blood in the healthy state; yet I have analyzed the blood taken from a diabetic patient, and never could detect the existence of sugar in the serum, nor any material difference in the other component parts. The alleged alteration in the chemical qualities of the urine is again contradicted by experiment. The point in dispute is, whether diabetic urine contains urea: or whether the presence of saccharine matter supersedes the other substances usually contained in this secretion? In another place + I have stated, that in all the experiments which I made on diabetic urine of different patients, and at different periods of the disease, urea was always detected, and likewise all the ingredients of healthy urine. That opinion has been confirmed by subsequent experience, and has received additional confirmation by the accurate analysis of diabetic urine by Dr Bostock and by Dr William Henry. So well established is that opinion on the basis of experiment and observation, that I am not disposed to relinquish it, although the analysis by Messrs Nicholas and Gueudeville gives a different result, and their conclusions are supported by MM. Dupuytren and Thenard. The source of error will probably be detected in some future trials, and the apparent contradictions may then be reconciled.

Another important point is, the proportion which the quantity of urine discharged bears to the substances taken into the sto

* Metz, Diabetis Observatio, in Disp. Med. Pract. Haller, tom. IV.

+ Vide Edinburgh Review, Vol. III, p.420.

Annales de Chimie, tom. LIX. Nicholson's Journal, Vol. XX.

mach. The more minutely this circumstance is investigated, the more nearly the quantity of egesta and ingesta will be found to correspond.

This subject brings me to the opinion which Dr Latham has delivered on the criticism of Aretæus. He thinks an unwarrantable attack has been made upon the accuracy of the Cappadocian, and he has translated the chapter Ig Antes, to put the reviewer's knowledge of Greek to the test. With what labour and accuracy the convenient works of Schrevelius, Hede rick, and Johnson, have been thumbed, a reference to the critical analysis in the last Number of this Journal will sufficiently explain. "Diabetes is a wonderful affection," (says Aretæus) "not very common among men:" which authorises the conclusion drawn, that he had seen very few cases of it; and his acknowledged accuracy is impeached, by his describing the patients as making urine without intermission, besides other symptoms, which even his advocate admits must be ascribed to ischuria.

With regard to the causes of diabetes, there does not appear any necessity for any confession of error, because the common mistake of making Aretæus attribute the disease to the bite of the dipsas is studiously avoided. Nothing is mentioned in the article alluded to about the serpent; and the passage in the original cannot be understood in any other manner than as an illustration;-it is introduced in a conditional sense.

The following summary may perhaps give an impartial statement of the facts, and best authenticated opinions concerning diabetes.

Diabetes appears to be a disease of the whole system, and not confined to any morbid action of one particular part. This is rendered probable by the symptoms, by the remote causes, by the effects of remedies, and by analogy with other diseases.

The state of the skin, excessive thirst, emaciation, sometimes without corresponding debility of the muscular powers, inordinate appetite, saccharine quality of the urine, are the most common characteristics of the disease.

An increased quantity of urine in proportion to the liquid ingesta, and saccharine matter in the urine, are not necessary to constitute that morbid condition called diabetes: since the quan tity of urine discharged, in most cases, corresponds with the quantity of fluids drank, sometimes does not amount to more than three pints in twenty-four hours, and sometimes the urine is perfectly free from saccharine matter. The disease is seen in persons of both sexes; and attacks from the age of eight to seventy years. I have seen a girl eight years old affected with it. It seems also to be hereditary. I knew two brothers, both

of whom died of diabetes mellitus; and Frank * mentions several instances of the same kind. It is not confined to the human race, for cows and horses are sometinics affected with it, and perhaps it may be observed in other animals. The serum of the blood of diabetic patients contains no sugar; and the urine is not without urea. Animal diet relieves the symptoms, and soon influences the urinary secretion: but it becomes loathsome after a time, and seldom is continued till all the symptoms of the disease are removed.

Opium is one of the best medicines in diabetes; it removes uneasy sensation, quiets the agitated mind of the patient: hence indirectly diminishes the quantity of urine. It may be taken in large quantities, from two to six grains three times in the day, without producing sleep or stupor, and with evident advantage.

The method of treating diabetes, by a strict antiphlogistic regimen, abstinence, and repeated venesection, so ably pointed out by Mr Watt, I have had no opportunity of trying; but should not hesitate to adopt his practice, which is so well recommended by his cases, and by his observations on the treatment of this disease, published subsequently to his book, in the Fifth Volume of this Journal.. He there mentions, that all the patients whose cases he had published, continue in perfect health; a circumstance which establishes his facts, and gives the best illustration of the soundness of his doctrine.

* Epitome De Curand. Morbis, p. 42.

PART II.

CRITICAL ANALYSIS.

I.

Some Observations upon Diseases, chiefly as they occur in Sicily. By WILLIAM IRVINE, M. D. F. R. S. Ed. of the Royal Col lege of Physicians of London, and Physician to his Majesty's Forces. 8vo. pp. 120. Murray. London, 1810.

TH HOSE medical writings, which present us with a view of diseases, under various circumstances of climate and different modes of life, delineated upon the spot by a diligent and faithful observer, afford us the most agreeable exercise of our critical function. They not only interest us by the novelty of the facts which they communicate, but they serve as a sort of touchstones, by which we may ascertain the value of our theories and practical precepts, as they result from the limited views to which our own local situation necessarily confines us. The sound sense and unaffected perspicuity of language which are manifest on opening this little volume, led us to anticipate much satisfaction from Dr Irvine's observations; and the perusal of the work, which, we think, in proportion to its extent, may not shrink from a comparison with that of his learned predecessor in the same climate, Dr Cleghorn, fully justified our anticipations. The only imperfection in the value of these observations, which can suggest itself, arises from a doubt which is left upon the mind of the reader, relative to the length of time during which they were collected. They are detailed in a terse and aphoristic style, as if they were the result of a long and cautious induction, which had comprehended so large a view of the influence of the seasons, and of the physical, moral and political circumstances of the people, as might serve for the ground of an ample generalization. And, indeed, there is so much consistency in the observations in general, not only among themselves, but with the results of modern experience, under the di

rection of the ablest inquirers elsewhere, that we trust they are the inferences from a most ample research. All that we learn from the author, upon this point, is contained in a sentence or two in the preface; where he states, that the number of patients that have been under his treatment "has been very large;" and that "in the course of two months only, September and October 1808, there passed under his superintendance 163 patients, of whom 55 had continued fever, 50 intermittents, and 29 dysentery, for the greater part important and formidable cases.". "Few opportunities," he adds, "occur where, during an equal period, more ample or satisfactory experience could be presented. The patients were lodged in a building, admirably adapted to the purposes of an hospital, which was formerly the Collegeof Jesuits at Messina; and the management of them was left to the uncontrolled direction of the physician in every respect.

In the first chapter, Dr Irvine treats of "the climate of Sicily," and the other circumstances which constitute what has been called the medical topography of the island. The chief peculiarity of this climate, which is included between 36° and 36° of north latitude, is its heat; the whole summer being oppressively hot, the thermometer in the months of July and August standing on an average at 86° in the day, and not much lower in the night. Nor is there often much actual cold in the winter; for the thermometer seldom sinks below 50°, between the months of November and May, but commonly ranges between that degree and 65° or 70°. Nevertheless "the vicissitudes of heat, " Dr Irvine observes, are very great; and I have often seen an alteration of 20° in the temperature within twenty-four hours of consequence local inflammations are common during the winter season, and phthisis pulmonalis is frequently fatal." (p. 2.) The comparative healthiness of the seasons on the shores of the Mediterranean still continues the same as in the times of Hippocrates, Celsus, and Galen. The unhealthy season in Sicily occurs during the summer and autumn: by far the greatest number of deaths happen in these periods; the other seasons of the year are comparatively free from disease."* (p. 7.) The heat

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* The reader will recollect the statement given by Celsus from Hippocrates : "Saluberrimum ver est; proxime deinde ab hoc, hiems; periculosior æstas; autumnus longe periculosissimus. (Lib. II. cap. 1.) This maxim, that the summer and autumn were the most sickly seasons, is not only verified, Sir J. Pringle remarks, in the warmer climates, but also in camps, where men are much exposed to heat and moisture, (and, it should be added, to animal and vegetable effluvia), the great causes of putrid and contagious diseases. (On Dis. of the Army, Part II. chap. 1.) The absolute reverse of this is now true, in our own climate, since the