the intestines, an effort was made to counteract the pernicious effect on the system caused by the absence of the former secretion, by giving 1½ grains of pancreatine in the form of pill three times a day. During the period that the patient was taking this medicine, the quantity of fat passed by stool was supposed to diminish. No decided improvement in the patient's condition took place, however, and on the 2nd of November the gentleman was brought to me by his medical attendant. At this time the patient was much in the state already described,[22] and after a careful physical examination, I failed to elicit any new fact of importance. The hepatic dulness was perfectly natural; there was no tenderness to speak of, no history of gall-stones, and {74} no evidence of any tumour beyond the doubtful fulness in the pancreatic region. The digestive, and other functions of the body, except those already mentioned, seemed unimpaired, and yet the patient's strength daily declined. As physical as well as symptomatical diagnosis proved inadequate to unravel the mystery of this obscure case, and as chemical means had already, in as far as it had been tried, been of advantage, it was resolved to subject the excretions to a rigid chemical examination. The patient was accordingly desired to collect all the urine he passed during twenty-four hours, and while I analysed it, Dr. Prance examined the stools, in order to ascertain their composition--especially as regarded the amount of fatty and albuminous matters contained in them. The urine yielded on analysis the following result:-- 24 HOURS' URINE. Quantity (55 oz.) . . . . . . . . . . . . . . . . . . 1705 c.c. Reaction . . . . . . . . . . . . . . . . . . . . . . Acid. Specific gravity . . . . . . . . . . . . . . . . . . 1018. Colour . . . . . . . . . . . . . . . . . . . . . . Greenish yellow. Urea . . . . . . . . . . . . . . . . . . . . . . . . 27·28 grammes. Uric acid (crystals large, and of a dark-green colour) 0·511 " Bile acids[23] . . . . . . . . . . . . . . . . . . . Abundant. {75} Bile pigment[24] . . . . . . . . . . . . . . . . . . Abundant. Albumen . . . . . . . . . . . . . . . . . . . . . . . None. Sugar . . . . . . . . . . . . . . . . . . . . . . . . None. [Footnote 22: I noted his state to be as follows:--Skin of a black jaundiced tint (dark green). Eyes deeply stained. Lips anæmic. Considerable emaciation and debility. Extreme languor. Appetite good. Tongue, and pulse not remarkable. Slight pain on pressure over the gall-bladder. Indistinct fulness in pancreatic region, and to the left of middle line.] [Footnote 23: On the addition of sulphuric acid, and white sugar to the urine, a very marked, and beautiful purple hue was obtained.]