MEDICINE AND SURGERY. 67 strain the elimination of sugar. But the goal | grammes (2 to 1 drachm) daily. Similar is to restore the power of assimilating carbohydrates, and until this purpose has been achieved we may speak, indeed, of the arrest but not the cure of diabetes. In the ensuing discussion Seegen gave a summary of the results of his own investigations. He believes that the liver is constantly forming sugar, not, as Bernard thought, from glycogen, but from albuminoids and fats. This sugar, elaborated in the liver and thrown into the circulation, is constantly being consumed and destroyed by the tissues. Since the formation of sugar is furthered by a liberal supply of carbonaceous material, it follows that normally almost the entire pabulum is utilized in the formation of sugar. This elaboration, in fact, ranks as one of the most important functions of the body, sugar being so intimately concerned in the generation of animal heat and mechanical power. Glycogen is principally constructed from carbohydrates. In the light of these experimental results Seegen recognizes two forms of diabetes. In one sugar is only excreted when carbohydrates enter into the diet. Even in such cases the liver has lost its power of forming glycogen from the carbohydrates, or, if formed, of turning it to good account. In the second form Sugar escapes when not a particle of hydrocarbonaceous food is consumed. This sugar, built up within the economy, serves, by its oxidation, as fuel for work. In this latter variety the cells of the entire organism have lost their power of transforming sugar. These two forms of the disease have, consequently, a very different significance. Life may long be preserved in the first variety, providing that carbohydrates be excluded from the bill of fare, while the second form rapidly carries its victim to his grave. The recognition of these two varieties by Professor Seegen is the outcome of the experience of thirty years and the examination of more than 1000 diabetic patients. results have attended the use of phenacetin, exalgin, and antifebrin. Minkowski spoke of the production by himself and v. Mering of diabetes by extirpation of the pancreas, and the influence of disease of that gland in the genesis of the disease. De Renzi and Reale, of Naples, have pursued a course of experiments in regard to the causation of diabetes, and have found that it may be produced by ablation of several organs. Among these, in the order of their importance, were mentioned the pancreas, duodenum, and salivary glands. They failed to observe glycosuria after every case of removal of the pancreas, this result occurring in only 75 per cent. of the number. Clinical observation has shown that the loss of the salivary secretion gives rise to some of the most important symptoms of diabetes, and these researches fully confirm the fact in various acute and chronic disorders. The diastatic property of the saliva has recently been made the subject of an investigation by Dr. Romaro Vittorio * He found that this influence of the saliva was generally lessened in diathetic maladies. This is the case in the advanced stage of diabetes, and the author suggests that chemical examination of the saliva may be capable of throwing light upon the severity of the disease. The constitution of the saliva, gastric juice, and sweat has been studied anew by Ponomaroff, who is unable to agree with the statement of Heller and Frick that in diabetes these fluids contained sugar. When vomiting has been artificially produced bile is mingled with the contents of the stomach. As the bile generally contains sugar, it is probable that an error was made in considering that the sugar was present in the gastric juice, and that it was really derived from the bile. Professor Rosenstein, of Leyden, has carefully observed the digestive function in 10 patients suffering from diabetes, and, as a result, feels himself warranted in drawing the following conclusions: 1. In one class of gastric juice for a shorter or longer period, and this absence is the result of a neurosis of the Dujardin-Beaumetz looks upon the new anti-cases free hydrochloric acid is absent from the pyretics and analgesics as constituting a noteworthy improvement in the medicinal treatment of diabetes. He has repeatedly seen a decided decrease of polyuria and glycosuria follow the For these and the succeeding references we are indebted to our valued exchange, the Deutsche Medizinal-Zeitung, Novem The diabetes which v. Mering produ the administration of phloridzin has further studied by Drs. Moritz and Pra Phloridzin is a toxic glucoside obtaine the root-bark of the apple-, pear-, plu cherry- tree. Not only this substance b its derivative phloretin give rise to gly irrespective of the diet, and even in fan animals. The quantity of sugar contai the urine is high, ranging from 6 to cent. The absolute amount depends up dose of phloridzin administered, and upon the quantity of nitrogenous and food ingested. 2. In a second class, extensive atrophy | bladder had probably been secreted bef of the gastric mucous membrane exists in con- operation. sequence of an interstitial gastritis. 3. When free hydrochloric acid is persistently absent from the gastric juice, an interstitial inflammation has led to atrophy of the glandular follicles. 4. The diabetic neurosis of the stomach, like absence of the patellar reflex, and other nervous symptoms, does not depend directly upon the severity of the disease as regards the quantity of sugar in the urine, but upon the presence of aceton or diacetic acid. Dr. W. Prausnitz, of Munich, as a result of his experimental studies in fowls, concludes that glycogen is elaborated chiefly, if not exclusively, by the liver, and is by that organ distributed to other portions of the body. The absolute and relative quantity of this substance stored up within the liver is in close dependence upon the size of that organ. The larger the liver, the richer the supply of cane-sugar, the greater is the quantity of glycogen. The larger the liver, the greater is its supply of blood and the larger the amount of glycogen produced. Prausnitz was unable to discover glycogen in the circulating blood of swine killed during digestion. Hence, he conceives that glycogen, as such, is seldom thrown into the blood by the liver, but generally transformed into grape-sugar before entering the circulation. The valuable experiments of Minkowski and v. Mering have already been mentioned in this journal.* In further communications they announce that, in general, diabetes will not develop if a small piece of the pancreas be left behind, even if that small piece be no longer in connection with the intestine. In 2 cases in which the remnant did not exceed or of the gland, severe diabetes arose. They consider, moreover, that the many failures which have attended the effort to produce experimental diabetes are due to faults in the method of operating. In 18 out of 21 cases they succeeded in producing veritable diabetes with polydipsia, polyphagia, polyuria, and emaciation. Besides sugar the urine contained acetone, acetic and butyric acids. In the 3 negative cases death occurred so soon that the normal urine found in the In 1884 E. Fischer pointed out that p hydrazin enters into combination with hydes, ketones, and sugars, forming sugars, the so-called azone. Thus, grap and lævulose give rise to phenylglucos a yellow substance which crystallizes needles and fuses at 204° to 205° C. (3 4010 F.). Moritz has now obtained normal urine a substance precisely sim phenylglycosazon, and fusing constantly same temperature (204° to 205° C.). this he concludes that grape-sugar is con in normal urine. He demonstrated the ence of a transitory glycosuria due to al by examining the urine of 8 persons after partaking of an abundant meal carbohydrates. Sugar was found in ea stance. It usually disappeared in two o hours, but in one case it persisted till the hour. An interesting observation has made by Dr. Fritz Schenck, of Bonn, co ing the relation of grape-sugar to the alb of the blood. Schenck found that wh added grape sugar to blood, serum, or so of the albumens of the blood, only a I of the sugar could be recovered from the after coagulation. When the coagulu washed with water or alcohol until the or alcoholic extract contained no trac reducing substance, and then boiled dilute hydrochloric acid, glucose again its appearance. Under favorable circum the quantity of sugar was such that it apparent loss was due to a combination of the sugar with the albumen of the blood, though the nature of the combination cannot at present be explained. An abstract of the ingenious theory of Professor Lepine, concerning the pathogeny of diabetes, has already been given in our columns,* and need not now be rehearsed. Other communications have followed from his pen. One, relative to a proposed plan of treatment, may be briefly cited. An elderly woman, who had long suffered from diabetes, and whose urine had a sour smell, had epileptiform attacks, hallucinations, elevated temperature, headache, and great debility. An intra-venous injection of bicarbonate of sodium failed to afford relief, and coma supervened, in which the patient died. The urine, after the injection, was of neutral or feebly alkaline reaction, and contained but half as much sugar as before. At the autopsy fatty degeneration of the pancreas was observed. Lepine believes that the injection aggravated the cerebral symptoms and hastened death. The A valuable clinical communication has been made by Professor Rosenbach, of Breslau. The facts given by this author are unimpeachable, since they are drawn from an exact examination of the urine of all cases which came under his care during a period of ten years, both in private and public practice. writer has, in this manner, satisfied himself of the extremely common occurrence of mellituria among all classes of people. In a considerable number of cases hæmorrhage from the stomach or bowels coincided with the ap pearance of sugar in the urine. These hæmorrhages were not due to an ulcer, but came from the mucous membrane. Bleeding, not occasioned by an ulcer or hæmorrhoids, always led Rosenbach to suspect the existence of diabetes. Bleeding from the kidneys and bladder also possesses the same, though not as high, diag nostic value. After diabetes has existed for some years the liver progressively increases in size. After the organ has obtained a certain volume, a greater or less quantity of albumen generally appears in the urine, while the sugar temporarily disappears, or, at least, diminishes. In some cases ascites follows, and sudden death takes place from profuse gastric and intestinal * MEDICAL BULLETIN, April, 1890, p. 132. hemorrhages. The albuminuria represents an attempted regulation by which unutilized nitrogenous material shall be removed. Faulty assimilation of albumen is now superadded to the faulty elaboration of carbohydrates. The system must struggle with a double deficit. These examinations confirmed the generally held opinion that prolonged mental strain begets diabetes. A not inconsiderable but fugitive glycosuria was observed after indulgence in champagne, various kinds of Bavarian beer, pure honey, and fruit. In connection with the literature of pancreatic diabetes a case reported by J. T. Collier may be mentioned. A man, aged 48 years, though pale and weak, had regarded himself as fairly healthy, but had suffered for several years from flatulent dyspepsia and pain after eating. Finally, he began to emaciate rapidly, and sugar was found in the urine. After six weeks of antidiabetic regimen the sugar had almost completely disappeared, but failure continued, and a deeply situated tumor was discovered in the abdomen. The man died suddenly, and the head of the pancreas was found carcinomatous. At an opposite point the anterior wall of the stomach was infiltrated, and a small perforation had occasioned death. CORRESPONDENCE. THE KOCH HYPODERMIC SYRINGE. THE new method of treatment of various forms of tuberculosis, introduced by Dr. Robert Koch, of Berlin, has been enthusiastically taken up by the press, both lay and medical, and has been very favorably received by the profession, who have it now under trial under rigid tests and with all the scientific appliances and skill that its assumed importance warrants and the claims made for its demand. It will certainly require a twelvemonth-perhaps several years-to fully determine the exact position of the new remedy in therapeutics, which promises to be an important one, though certainly not the panacea that the public press pronounced it upon its first appearance. Whatever may be the fate of the remedy, the technique of the method is perfect. For the treatment of a septic disease, appliances absolutely aseptic are necessary. Here the laboratory comes forward and confers a boon upon practical medicine by presenting us with an aseptic hypo- | be instantly taken apart, and the essential parts dermic syringe. The small but essential instrument used by Dr. Koch, and made under his orders and direct supervision, one of which has been placed in my hands through the great kindness of the importers and agents of the manufacturer in this country, the Messrs. Eisner & Mendelson Co., of New York, consists of several parts, easily separated to be cleaned and easily readjusted for use. First the barrel of the syringe is of glass, as usual, but it is thicker and stronger than in the ordinary instrument of the shops. It is also about the usual size and shape, except that it is narrowed abruptly near one extremity, and presents a ground and slightly roughened surface, upon which an ordinary hollow needle of steel or platinum is accurately fitted by a friction-joint. The exterior of the upper extremity is also ground to a short distance, so as to permit the application of a silverplated cap, about 1 inch in length, bearing upon its upper end a small rubber ball. The cap being hollow, compression of the elastic ball boiled in water, or treated with antiseptic solutions so as to completely sterilize them and preclude any possibility of their infecting a patient or of carrying infection from one to another. The instrument, accompanied by two needles, is in a small morocco case, from the end of which the rubber ball projects. With an instrument of this form, all the ordi- . nary uses to which the hypodermic syringe is applied can be met equally as well, and with absolute security against infection. As abscesses and cellulitis, or erysipelas, have been traced to a contaminated hypodermic syringe, these accidents can be entirely avoided by Koch's instrument, which appears to be the best hypodermic syringe for all purposes to which such instruments are applied in ordinary medical practice, and probably the most convenient, since it is always in order and there are no valves to get dry, or, on the other hand, to keep moist and breed bacteria. FRANK WOODBURY. 218 S. 16TH ST., PHILA. forces its contents (air) through the metallic socket, or cap, into the glass barrel, displacing the contents of the latter, in turn, through its inferior extremity and the needle, when in situ. A peculiar feature of the syringe not yet mentioned is a small stop-cock, or valve, in the metallic connection between the rubber ball and the hypodermic syringe proper. This can be turned after the barrel of the instrument is filled, so as to prevent premature discharge of its contents, and, on the other hand, when opened, the ball can be compressed, forcing the contents of the syringe through the needle; now, if the valve be again turned, the ball will expand and resume its shape, without drawing back the injected material through the needle. The glass barrel has a capacity of I cubic centimetre, and is graduated by a scale cut into one side, in tenths. The special feature of the syringe that constitutes it a new departure and a decided improve ment over the usual forms of this instrument is, of course, the fact that it does away with the piston and plunger, which, coming in contact with the fluids employed, is constantly contaminated, and, as it is made of leather or similar material, it cannot be sterilized in the only effectual way, by heat. The Koch syringe can MEDICAL NEWS AND MISCELLANY. DR. SARGENT, of Bryn Mawr, Pa., died on January 11th, aged 56 years. DR. H. ERNEST LAPLACE has been elected Secretary of the Medico-Chirurgical College. DR. SAMUEL WOLFE has removed to 1532 Diamond Street, Philadelphia. THE Philadelphia Dental College has just issued a handsome and well-illustrated announcement for 1891. THE Medical Register for New England is edited by Dr. Francis H. Brown, 283 Washington Street, Boston. DR. JAMES F. STONE has a well-equipped gymnasium for children at 1806 Green Street, Philadelphia. DR. HENRY M. MARTIN, a retired surgeon in the United States Navy, died recently in this city. DR. GRENFELL BAKER, who was family physician to the late Sir Richard Burton, is engaged on a biography of the distinguished traveler. DR. D. G. BRINTON was given a reception, January 8th, by the Numismatic and Antiquarian Society, on the opening of their new hall. DR. R. A. RANDALL was elected Clinical Professor of Otology, at the University, to succeed Dr. George Strawbridge. DR. WILLIAM O. W. HALL, son of Dr. David Hall, of Lewees, Del., has removed his residence to No. 352 Decatur Street, Brooklyn, N. Y. THE annual meeting of the contributors of the Medico-Chirurgical Hospital of Philadelphia, held this month, showed an increased activity, especially financially, for the institution. ALUMNI MEETING.-A large and very representative gathering of the Alumni of the MedicoChirurgical College was held in the arena, January 16th. DR. BAXTER'S SUCCESSOR.-The President has appointed Colonel Charles Sutherland, Surgeon, to be Surgeon-General, with the rank of Brigadier-General, vice J. H. Baxter, deceased. TUBERCULOSIS AND THE KOCH TREATMENT. -Dr. John H. Musser delivered a lecture before the Young Men's Christian Association of this city on the Koch treatment of tuberculosis, January 23d. DR. JOHN A. REYBURN, of Elkham, W. Va., recently one of the resident physicians of the Medico-Chirurgical Hospital of Philadelphia, was married, on January 7th, to Miss Margaret Kelly of this city. DR. EPHRAIM CUTTER, President of the New York Branch of Society of Science, Letters, and Art, of London, recently delivered an address to the members in New York City on "The Relations of Medicine and Music." THE EPISCOPAL HOSPITAL.-At a meeting of the Board of Managers of the Episcopal Hospital, held last month, Dr. G. Oram Ring, Chief of the Ear and Throat Department of Beacon Dispensary, and Assistant-Surgeon of Wills' Eye Hospital, was elected Ophthalmic and Aural Surgeon of the institution. INJECTIONS OF THE LYMPH.-The Board of Health of Vienna has decreed that every case of lymph inoculation is to be notified to the authorities, and both physician and patient carefully watched. In every instance a declaration as to the origin of the lymph is to be made with the greatest precision and detail. DISPENSARY FOR WOMEN'S DISEASES.-A dispensary for the treatment of the diseases of women amenable to electricity has been opened at 1632 Cherry Street, Philadelphia, under the charge of Drs. G. Betton Massey and Horatio R. Bigelow. Physicians are invited to bring or send suitable cases on Mondays, Wednesdays, and Fridays, at 3 P.M. PREVENTION OF CONCEPTION.-The Detroit Medical and Library Association recently concluded that general contention was that the practice is proper and right, and it was also held that the prevention could be accomplished mechanically without injury to either the man or the woman. There were but few opposed to this view.-Medical Age. THE PRESCRIPTION.-The first number of this bright, neat, handy, and well-arranged journa has just been published. It abounds in practical hints and matters of interest, and reflects much credit upon the editor, Dr. William C. Wile, of Danbury, Conn., the home of its publication. The printing company have printed and bound The Prescription in a most acceptable form for the busy physician. IN KOCH'S LABORATORY.-Passed Assistant DR. RALPH STOCKMAN of Edinburgh, Scot- Surgeon Kinyoun of the Marine-Hospital Serland, has been appointed External Examiner in vice, who was recently sent by the Marine-HosMateria Medica and Pharmacy, and in Pharma-pital Bureau to Berlin to enter Koch's laboratory, cology and Therapeutics, in succession to Dr. reported by cable, January 7th, his arrival, and Mitchell Bruce, who has resigned. asked for authority to purchase the necessary The authority was immediately apparatus. granted. Dr. Kinyoun will remain in the laboratory three months. CHARITABLE BEQUESTS. - Dr. William H. Bennett, physician in charge of St. Christopher's Hospital, of Philadelphia, for Sick Children, acknowledges the receipt of $3000 from Mrs. Caroline G Tait, and of $3000 from Miss Rebecca Gibson. THE NEW YORK ACADEMY OF Medicine.— At the meeting held at 17, 19, and 21 West 43d Street, of the Section on Obstetrics and Gynæ |